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Daily D, Bridges J, Mo WB, Mo AZ, Massey PA, Zhang AS. Coccydynia: A Review of Anatomy, Causes, Diagnosis, and Treatment. JBJS Rev 2024; 12:01874474-202405000-00004. [PMID: 38709859 DOI: 10.2106/jbjs.rvw.24.00007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
» Coccydynia is a painful condition affecting many patients at the terminal caudal end of the spine.» An understanding of coccyx anatomy and variations of morphology is necessary for proper diagnosis. A multifactorial etiology for pain may be responsible for this clinical entity.» Several treatment options exist. Successful outcomes for patients depend on individual patient characteristics and the etiology of pain.
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Affiliation(s)
- Drayton Daily
- Department of Orthopaedic Surgery, Louisiana State University-Shreveport, Shreveport, Louisiana
| | - James Bridges
- School of Medicine, Louisiana State University-Shreveport, Shreveport, Louisiana
| | - William B Mo
- Department of Orthopaedic Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Andrew Z Mo
- Department of Orthopaedic Surgery, MedStar Georgetown University Hospital, Washington, District of Columbia
| | - Patrick Allan Massey
- Department of Orthopaedic Surgery, Louisiana State University-Shreveport, Shreveport, Louisiana
| | - Andrew S Zhang
- Department of Orthopaedic Surgery, Louisiana State University-Shreveport, Shreveport, Louisiana
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O'Neill NP, Mo AZ, Miller PE, Glotzbecker MP, Li Y, Fletcher ND, Upasani VV, Riccio AI, Spence D, Garg S, Krengel W, Birch C, Hedequist DJ. The Reliability of the AO Spine Upper Cervical Classification System in Children: Results of a Multi-Center Study. J Pediatr Orthop 2023; 43:273-277. [PMID: 36706430 DOI: 10.1097/bpo.0000000000002363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND There is no uniform classification system for traumatic upper cervical spine injuries in children. This study assesses the reliability and reproducibility of the AO Upper Cervical Spine Classification System (UCCS), which was developed and validated in adults, to children. METHODS Twenty-six patients under 18 years old with operative and nonoperative upper cervical injuries, defined as from the occipital condyle to the C2-C3 joint, were identified from 2000 to 2018. Inclusion criteria included the availability of computed tomography and magnetic resonance imaging at the time of injury. Patients with significant comorbidities were excluded. Each case was reviewed by a single senior surgeon to determine eligibility. Educational videos, schematics describing the UCCS, and imaging from 26 cases were sent to 9 pediatric orthopaedic surgeons. The surgeons classified each case into 3 categories: A, B, and C. Inter-rater reliability was assessed for the initial reading across all 9 raters by Fleiss's kappa coefficient (kF) along with 95% confidence intervals. One month later, the surgeons repeated the classification, and intra-rater reliability was calculated. All images were de-identified and randomized for each read independently. Intra-rater reproducibility across both reads was assessed using Fleiss's kappa. Interpretations for reliability estimates were based on Landis and Koch (1977): 0 to 0.2, slight; 0.2 to 0.4, fair; 0.4 to 0.6, moderate; 0.6 to 0.8, substantial; and >0.8, almost perfect agreement. RESULTS Twenty-six cases were read by 9 raters twice. Sub-classification agreement was moderate to substantial with α κ estimates from 0.55 for the first read and 0.70 for the second read. Inter-rater agreement was moderate (kF 0.56 to 0.58) with respect to fracture location and fair (kF 0.24 to 0.3) with respect to primary classification (A, B, and C). Krippendorff's alpha for intra-rater reliability overall sub-classifications ranged from 0.41 to 0.88, with 0.75 overall raters. CONCLUSION Traumatic upper cervical injuries are rare in the pediatric population. A uniform classification system can be vital to guide diagnosis and treatment. This study is the first to evaluate the use of the UCCS in the pediatric population. While moderate to substantial agreement was found, limitations to applying the UCCS to the pediatric population exist, and thus the UCCS can be considered a starting point for developing a pediatric classification. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Nora P O'Neill
- Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Andrew Z Mo
- Boston Children's Hospital, Harvard Medical School, Boston, MA
| | | | - Michael P Glotzbecker
- Rainbow Babies and Children's Hospital, Case Western Reserve University School of Medicine, Cleveland, OH
| | - Ying Li
- C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, MI
| | | | - Vidyadhar V Upasani
- Rady Children's Hospital, University of California, San Diego, San Diego, CA
| | | | - David Spence
- Le Bonheur Children's Hospital, University of Tennessee-Campbell Clinic, Memphis TN
| | - Sumeet Garg
- University of Colorado School of Medicine, Aurora, CO
| | - Walter Krengel
- Seattle Children's Hospital, University of Washington, Seattle, WA
| | - Craig Birch
- Boston Children's Hospital, Harvard Medical School, Boston, MA
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Mo AZ, Miller PE, Pizones J, Helenius I, Ruf M, El-Hawary R, de Oliveira RG, Ovadia D, Kawakami N, Crawford H, Odent T, Yazici M, Johnson MB, Miyanji F, Hedequist DJ. The reliability of the AOSpine Thoracolumbar Spine Injury Classification System in children: an international validation study. J Child Orthop 2021; 15:472-478. [PMID: 34858534 PMCID: PMC8582611 DOI: 10.1302/1863-2548.15.200188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 08/03/2021] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To evaluate the AOSpine Thoracolumbar Spine Injury Classification System and if it is reliable and reproducible when applied to the paediatric population globally. METHODS A total of 12 paediatric orthopaedic surgeons were asked to review MRI and CT imaging of 25 paediatric patients with thoracolumbar spine traumatic injuries, in order to determine the classification of the lesions observed. The evaluators classified injuries into primary categories: A, B and C. Interobserver reliability was assessed for the initial reading by Fleiss's kappa coefficient (kF) along with 95% confidence intervals (CI). For A and B type injuries, sub-classification was conducted including A0-A4 and B1-B2 subtypes. Interobserver reliability across subclasses was assessed using Krippendorff's alpha (αk) along with bootstrapped 95% CIs. A second round of classification was performed one-month later. Intraobserver reproducibility was assessed for the primary classifications using Fleiss's kappa and sub-classification reproducibility was assessed by Krippendorff's alpha (αk) along with 95% CIs. RESULTS In total, 25 cases were read for a total of 300 initial and 300 repeated evaluations. Adjusted interobserver reliability was almost perfect (kF = 0.74; 95% CI 0.71 to 0.78) across all observers. Sub-classification reliability was substantial (αk= 0.67; 95% CI 0.51 to 0.81), Adjusted intraobserver reproducibility was almost perfect (kF = 0.91; 95% CI 0.83 to 0.99) for both primary classifications and for sub-classifications (αk = 0.88; 95% CI 0.83 to 0.93). CONCLUSION The inter- and intraobserver reliability for the AOSpine Thoracolumbar Spine Injury Classification System was high amongst paediatric orthopaedic surgeons. The AOSpine Thoracolumbar Spine Injury Classification System is a promising option as a uniform fracture classification in children. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Andrew Z. Mo
- Department of Orthopaedic Surgery, Georgetown University Medical Center, Washington, District of Columbia, United States
| | - Patricia E. Miller
- Department of Orthopaedic Surgery, Boston Children’s Hospital, Boston, Massachusetts, United States
| | - Javier Pizones
- Spine Unit, Hospital Universitario La Paz, Madrid, Spain
| | - Ilkka Helenius
- Professor and Chairman, Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Michael Ruf
- Center for Spinal Surgery, Orthopedics, and Traumatology, SRH Klinikum Karlsbad-Langensteinbach, Karlsbad, Germany
| | | | | | - Dror Ovadia
- Dana Dwek Children’s Hospital, Tel Aviv Medical Center, Tel Aviv, Israel
| | - Noriaki Kawakami
- Director of Spine & Scoliosis Center, Department of Orthopedic Surgery, Ichinomiyanishi Hospital, Ichinomiya, Japan
| | - Haemish Crawford
- Paediatric Orthopaedic Surgeon, Starship Children’s Hospital, Auckland, New Zealand
| | - Thierry Odent
- Service de Chirurgie Orthopédique Pédiatrique, Université François Rabelais de Tours, PRES Centre-Val de Loire Université, Hôpital Gatien-de-Clocheville, Tours, France
| | - Muharrem Yazici
- Hacettepe University, Faculty of Medicine, Orthopaedics, Ankara, Turkey
| | | | - Firoz Miyanji
- Department of Orthopedics, British Columbia Children’s Hospital, Pediatric Orthopedics and Spine Surgery, Vancouver, British Columbia, Canada
| | - Daniel J. Hedequist
- Department of Orthopaedic Surgery, Boston Children’s Hospital, Boston, Massachusetts, United States,Correspondence should be sent to Daniel J. Hedequist, Department of Orthopedic Surgery, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA 02115United States. E-mail:
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Abstract
Back pain in sport is a common complaint and seen by athletes, trainers, and treating physicians. Although there are a multitude of pain generators, mechanical sources are most common. Certain sports can lead to increased mechanical and axial loading, such as competitive weightlifting and football. Common mechanical causes of pain include disk herniation and spondylolysis. Patients typically respond to early identification and conservative treatment. In others, surgical intervention is required to provide stability and prevent long-term sequelae.
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Affiliation(s)
- Andrew Z Mo
- Department of Orthopaedics, University of Miami Miller School of Medicine, 1120 Northwest 14th Street, 12th Floor, Miami, FL 33136, USA
| | - Joseph P Gjolaj
- Department of Orthopaedics, University of Miami Miller School of Medicine, 1120 Northwest 14th Street, 12th Floor, Miami, FL 33136, USA.
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Mo AZ, Mont MA, Grossman EL, Rahman OF, Murray DP, Hershman EB, Sgaglione NA. The Effect of the COVID-19 Pandemic on Orthopedic Practices in New York. Orthopedics 2020; 43:245. [PMID: 32674175 DOI: 10.3928/01477447-20200624-01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 05/14/2020] [Indexed: 02/03/2023]
Abstract
The SARS-CoV-2 (COVID-19) crisis has strained hospitals and health systems across the world. In the United States, New York City has faced a surge of cases as the epicenter of the North American outbreak. Northwell Health, as the largest regional health system in New York City, has implemented various practices and policies to adapt to the evolving situation and prepare for future global events. [Orthopedics. 2020;43(4):245-249.].
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Rahman OF, Murray DP, Zbeda RM, Volpi AD, Mo AZ, Wessling NA, Mina BA, Mendez-Zfass MS, Carpati CM. Repurposing Orthopaedic Residents Amid COVID-19: Critical Care Prone Positioning Team. JB JS Open Access 2020; 5:e0058. [PMID: 33117956 PMCID: PMC7408271 DOI: 10.2106/jbjs.oa.20.00058] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Omar F Rahman
- Department of Orthopaedic Surgery, Lenox Hill Hospital-Northwell Health, New York, New York
| | - Daniel P Murray
- Department of Orthopaedic Surgery, Lenox Hill Hospital-Northwell Health, New York, New York
| | - Robert M Zbeda
- Department of Orthopaedic Surgery, Lenox Hill Hospital-Northwell Health, New York, New York
| | - Alexander D Volpi
- Department of Orthopaedic Surgery, Lenox Hill Hospital-Northwell Health, New York, New York
| | - Andrew Z Mo
- Department of Orthopaedic Surgery, Lenox Hill Hospital-Northwell Health, New York, New York
| | - Nicholas A Wessling
- Department of Orthopaedic Surgery, Lenox Hill Hospital-Northwell Health, New York, New York
| | - Bushra A Mina
- Department of Internal Medicine, Lenox Hill Hospital-Northwell Health, New York, New York
| | - Matthew S Mendez-Zfass
- Department of Orthopaedic Surgery, Lenox Hill Hospital-Northwell Health, New York, New York
| | - Charles M Carpati
- Department of Internal Medicine, Lenox Hill Hospital-Northwell Health, New York, New York
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Abstract
Os odontoideum is a rare entity of the second cervical vertebra, characterized by a circumferentially corticated ossicle separated from the body of C2. The ossicle is a distinct entity from an odontoid fracture or a persistent ossiculum terminale. The diagnosis may be made incidentally on imaging obtained for the workup of neck pain or neurologic signs and symptoms. Diagnosis usually can be made with plain radiographs. MRI and CT can assess spinal cord integrity and C1-C2 instability. The etiology of os odontoideum is a topic of debate, with investigative studies supporting both congenital and traumatic origins. A wide clinical range of symptoms exists. Symptoms may present as nondescript pain or include occipital-cervical pain, myelopathy, or vertebrobasilar ischemia. Asymptomatic cases without evidence of radiologic instability are typically managed with periodic observation and serial imaging. The presence of atlantoaxial instability or neurological dysfunction necessitates surgical intervention with instrumentation and fusion for stability.
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Affiliation(s)
- Daniel J Hedequist
- From the Department of Orthopaedic Surgery, Boston Children's Hospital/Harvard Medical School, Boston, MA (Dr. Hedequist), and the Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, NY (Dr. Mo)
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Abstract
CASE Gorham-Stout disease (GSD) is a rare entity that is marked by progressive osteolysis and bone resorption. A 14-year-old boy who was being followed for scoliosis presented with a marked curve progression and kyphoscoliosis. Imaging revealed osteolysis of the posterior elements and the ribs, suggestive of GSD. The structural compromise threatened spinal cord compression. Preoperative sirolimus therapy was initiated to stabilize the disease prior to corrective instrumentation. A biopsy specimen that was obtained at the time of instrumentation showed lymphatic vascular spaces consistent with GSD. Sirolimus therapy with the addition of bisphosphonate therapy was continued postoperatively. CONCLUSION To our knowledge, this case report is the first to describe sirolimus therapy combined with surgery for GSD of the spine. The patient did well with consecutive medical optimization and surgical intervention, including postoperative sirolimus and bisphosphonate therapy.
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Affiliation(s)
- Andrew Z Mo
- Department of Orthopaedics, Lenox Hill Hospital, New York, NY
| | - Cameron C Trenor
- Division of Hematology/Oncology and Vascular Anomalies Center (C.C.T) and Department of Orthopedics (D.J.H.), Boston Children's Hospital, Boston, Massachusetts
| | - Daniel J Hedequist
- Division of Hematology/Oncology and Vascular Anomalies Center (C.C.T) and Department of Orthopedics (D.J.H.), Boston Children's Hospital, Boston, Massachusetts
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