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Luo S, Canavese F, Aroojis A, Andreacchio A, Anticevic D, Bouchard M, Castaneda P, De Rosa V, Fiogbe MA, Frick SL, Hui JH, Johari AN, Loro A, Lyu X, Matsushita M, Omeroglu H, Roye DP, Shah MM, Yong B, Li L. Are Generative Pretrained Transformer 4 Responses to Developmental Dysplasia of the Hip Clinical Scenarios Universal? An International Review. J Pediatr Orthop 2024:01241398-990000000-00534. [PMID: 38597198 DOI: 10.1097/bpo.0000000000002682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
OBJECTIVE There is increasing interest in applying artificial intelligence chatbots like generative pretrained transformer 4 (GPT-4) in the medical field. This study aimed to explore the universality of GPT-4 responses to simulated clinical scenarios of developmental dysplasia of the hip (DDH) across diverse global settings. METHODS Seventeen international experts with more than 15 years of experience in pediatric orthopaedics were selected for the evaluation panel. Eight simulated DDH clinical scenarios were created, covering 4 key areas: (1) initial evaluation and diagnosis, (2) initial examination and treatment, (3) nursing care and follow-up, and (4) prognosis and rehabilitation planning. Each scenario was completed independently in a new GPT-4 session. Interrater reliability was assessed using Fleiss kappa, and the quality, relevance, and applicability of GPT-4 responses were analyzed using median scores and interquartile ranges. Following scoring, experts met in ZOOM sessions to generate Regional Consensus Assessment Scores, which were intended to represent a consistent regional assessment of the use of the GPT-4 in pediatric orthopaedic care. RESULTS GPT-4's responses to the 8 clinical DDH scenarios received performance scores ranging from 44.3% to 98.9% of the 88-point maximum. The Fleiss kappa statistic of 0.113 (P = 0.001) indicated low agreement among experts in their ratings. When assessing the responses' quality, relevance, and applicability, the median scores were 3, with interquartile ranges of 3 to 4, 3 to 4, and 2 to 3, respectively. Significant differences were noted in the prognosis and rehabilitation domain scores (P < 0.05 for all). Regional consensus scores were 75 for Africa, 74 for Asia, 73 for India, 80 for Europe, and 65 for North America, with the Kruskal-Wallis test highlighting significant disparities between these regions (P = 0.034). CONCLUSIONS This study demonstrates the promise of GPT-4 in pediatric orthopaedic care, particularly in supporting preliminary DDH assessments and guiding treatment strategies for specialist care. However, effective integration of GPT-4 into clinical practice will require adaptation to specific regional health care contexts, highlighting the importance of a nuanced approach to health technology adaptation. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Shaoting Luo
- Department of Pediatric Orthopaedics, Shengjing Hospital of China Medical University, Shenyang, Liaoning
| | - Federico Canavese
- Department of Orthopaedic Surgery, School of Medicine, Stanford University, Palo Alto, CA
| | - Alaric Aroojis
- Department of Orthopaedic Surgery, School of Medicine, Stanford University, Palo Alto, CA
| | - Antonio Andreacchio
- Department of Orthopaedic Surgery, School of Medicine, Stanford University, Palo Alto, CA
| | - Darko Anticevic
- Pediatric Orthopedics Clinic of Pediatric Surgery and Orthopedics, Pediatric Institute of Southern Switzerland (IPSI), Via Athos Gallino, Bellinzona, Switzerland
| | | | - Pablo Castaneda
- Department of Orthopaedic Surgery, School of Medicine, Stanford University, Palo Alto, CA
| | - Vincenzo De Rosa
- Pediatric Orthopedics Clinic of Pediatric Surgery and Orthopedics, Pediatric Institute of Southern Switzerland (IPSI), Via Athos Gallino, Bellinzona, Switzerland
| | | | - Steven L Frick
- Department of Orthopaedic Surgery, School of Medicine, Stanford University, Palo Alto, CA
| | - James H Hui
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Ashok N Johari
- Pediatric Orthopedics Clinic of Pediatric Surgery and Orthopedics, Pediatric Institute of Southern Switzerland (IPSI), Via Athos Gallino, Bellinzona, Switzerland
| | - Antonio Loro
- Ufuk University Faculty of Medicine, Ankara, Turkey
| | - Xuemin Lyu
- Department of Orthopaedic Surgery, School of Medicine, Stanford University, Palo Alto, CA
| | - Masaki Matsushita
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | | | - David P Roye
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | | | - Bicheng Yong
- Department of Pediatric Orthopaedics, Beit CURE Children's Hospital of Malawi, Chichiri Blantyre, Malawi
| | - Lianyong Li
- Department of Pediatric Orthopaedics, Shengjing Hospital of China Medical University, Shenyang, Liaoning
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Katsma M, Liu H, Pan X, Ryan KJ, Roye DP, Chambers HG. Management and treatment of musculoskeletal problems in adults with cerebral palsy: Experience gained from two lifespan clinics. J Pediatr Rehabil Med 2024; 17:19-33. [PMID: 38552124 PMCID: PMC10977450 DOI: 10.3233/prm-240018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 03/07/2024] [Indexed: 04/02/2024] Open
Affiliation(s)
- Mark Katsma
- Department of Orthopedic Surgery, Balboa Naval Medical Center, San Diego, CA, USA
| | - Haiqing Liu
- Pediatric Orthopedic Department of Shantou University, Guangzhou Huaxin Orthopedic Hospital, Guangzhou, China
| | - Xiaoyu Pan
- Department of Physical Medicine and Rehabilitation, UT Southwestern Medical Center, Dallas, TX, USA
- Departments of Nutrition and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Kyle J. Ryan
- University of California San Diego, San Diego, CA, USA
- Department of Orthopedic Surgery and Rehabilitation, Rady Children’s Hospital, San Diego, CA, USA
| | - David P. Roye
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Henry G. Chambers
- University of California San Diego, Rady Children’s Hospital, San Diego, CA, USA
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3
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Matsumoto Y, Yoshii Y, Ikutomo A, Yagi M, Nishimura M, Kawasaki Y, Sarafian A, Kim H, Roye DP, Matsumoto H. Improvement in a post-stroke pediatric patient with hemiplegia: Use of a hand-arm bimanual intensive therapy with hybrid assistive limb. Brain Dev 2024; 46:68-72. [PMID: 37652813 DOI: 10.1016/j.braindev.2023.08.002] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 07/04/2023] [Accepted: 08/11/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Pediatric stroke is a rare medical condition that often leads to long-lasting motor and cognitive impairments. Although therapies for adults after a stroke are well described, treatments for motor deficits following a pediatric stroke are yet to be investigated. We report a case of pediatric stroke in the chronic phase, in which a combination of novel treatments resulted in a significant improvement in physical function. CASE REPORT A seven-year-old girl with a left hemispheric cerebral infarction lost almost all right upper extremity motor function. Following onabotulinumtoxinA treatment, she underwent hand-arm bimanual intensive therapy augmented with a hybrid assistive limb for 90 h over 15 days. Evaluation after the training revealed significant improvements in physical function, daily activities, and occupational performance. CONCLUSIONS This report highlights the importance of innovative combinations of techniques in the treatment of pediatric stroke.
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Affiliation(s)
- Yoko Matsumoto
- NikoNiko House Medical and Welfare Center, Kobe, Japan; Department of Public Health and Health Science, Kobe University Graduate School of Health Sciences, Kobe, Japan; Tokyo Metropolitan Fuchu Rehabilitation Center, Tokyo, Japan.
| | - Yuji Yoshii
- PorePore-no-Ki, Children Development Support Center, Himeji, Japan
| | - Akiyo Ikutomo
- NikoNiko House Medical and Welfare Center, Kobe, Japan
| | - Mariko Yagi
- NikoNiko House Medical and Welfare Center, Kobe, Japan; Department of Childhood Development and Education, Faculty of Human Science, Konan Women's University, Kobe, Japan
| | - Mio Nishimura
- NikoNiko House Medical and Welfare Center, Kobe, Japan
| | - Yoko Kawasaki
- NikoNiko House Medical and Welfare Center, Kobe, Japan
| | | | - Heakyung Kim
- Physical Medicine & Rehabilitation, The University of Texas Southwestern Medical Center, TX, USA
| | - David P Roye
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, MA, USA
| | - Hiroko Matsumoto
- Department of Orthopaedic Surgery and Sports Medicine, Boston Children's Hospital, MA, USA; Department of Orthopaedic Surgery, Harvard Medical School, MA, USA
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Matsumoto H, Fano AN, Quan T, Akbarnia BA, Blakemore LC, Flynn JM, Skaggs DL, Smith JT, Snyder BD, Sponseller PD, McCarthy RE, Sturm PF, Roye DP, Emans JB, Vitale MG. Correction: Re-evaluating consensus and uncertainty among treatment options for early onset scoliosis: a 10-year update. Spine Deform 2023; 11:263. [PMID: 36171501 DOI: 10.1007/s43390-022-00596-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Hiroko Matsumoto
- Department of Orthopedics and Sports Medicine, Boston Children's Hospital, Boston, MA, 02115, USA. .,Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, 02115, USA.
| | - Adam N Fano
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, NY, 10032, New York, USA
| | - Theodore Quan
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, NY, 10032, New York, USA
| | - Behrooz A Akbarnia
- Department of Orthopaedic Surgery, University of California San Diego, San Diego, CA, 92037, USA
| | | | - John M Flynn
- Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - David L Skaggs
- Department of Orthopaedics, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - John T Smith
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, 84113, USA
| | - Brian D Snyder
- Department of Orthopedics and Sports Medicine, Boston Children's Hospital, Boston, MA, 02115, USA.,Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, 02115, USA
| | - Paul D Sponseller
- Division of Pediatric Orthopaedics, Johns Hopkins University, Baltimore, MD, 21287, USA
| | - Richard E McCarthy
- Department of Orthopaedics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, AR, 72205, USA
| | - Peter F Sturm
- Department of Orthopedic Surgery, Cincinnati Children's Hospital, Cincinnati, OH, 45229, USA
| | - David P Roye
- Department of Orthopedics and Sports Medicine, Boston Children's Hospital, Boston, MA, 02115, USA.,Division of Pediatric Orthopaedic Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - John B Emans
- Department of Orthopedics and Sports Medicine, Boston Children's Hospital, Boston, MA, 02115, USA.,Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, 02115, USA
| | - Michael G Vitale
- Department of Orthopedics and Sports Medicine, Boston Children's Hospital, Boston, MA, 02115, USA.,Division of Pediatric Orthopaedic Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY, 10032, USA
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5
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Matsumoto H, Fano AN, Quan T, Akbarnia BA, Blakemore LC, Flynn JM, Skaggs DL, Smith JT, Snyder BD, Sponseller PD, McCarthy RE, Sturm PF, Roye DP, Emans JB, Vitale MG. Re-evaluating consensus and uncertainty among treatment options for early onset scoliosis: a 10-year update. Spine Deform 2023; 11:11-25. [PMID: 35947359 DOI: 10.1007/s43390-022-00561-1] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 07/23/2022] [Indexed: 11/26/2022]
Abstract
PURPOSE Consensus and uncertainty in early onset scoliosis (EOS) treatment were evaluated in 2010. It is currently unknown how treatment preferences have evolved over the past decade. The purpose of this study was to re-evaluate consensus and uncertainty among treatment options for EOS patients to understand how they compare to 10 years ago. METHODS 11 pediatric spinal surgeons (similar participants as in 2010) were invited to complete a survey of 315 idiopathic and neuromuscular EOS cases (same cases as in 2010). Treatment options included the following: conservative management, distraction-based methods, growth guidance/modulation, and arthrodesis. Consensus was defined as ≥ 70% agreement, and uncertainty was < 70%. Associations between case characteristics and consensus for treatments were assessed via chi-squared and multiple regression analyses. Case characteristics associated with uncertainty were described. RESULTS Eleven surgeons [31.7 ± 7.8 years of experience] in the original 2010 cohort completed the survey. Consensus for conservative management was found in idiopathic patients aged ≤ 3, whereas in 2010, some of these cases were selected for surgery. There is currently consensus for casting idiopathic patients aged 1 or 2 with moderate curves, whereas in 2010, there was uncertainty between casting and bracing. Among neuromuscular cases with consensus for surgery, arthrodesis was chosen for patients aged 9 with larger curves. CONCLUSION Presently, preferences for conservative management have increased in comparison to 2010, and casting appears to be preferred over bracing in select infantile cases. Future research efforts with higher levels-of-evidence should be devoted to elucidate the areas of uncertainty to improve care in the EOS population. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
- Hiroko Matsumoto
- Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA, 02115, USA.
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, 02115, USA.
| | - Adam N Fano
- Department of Orthopedic Surgery, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Irving Medical Center, 3959 Broadway, CHONY 8-N, New York, NY, 10032, USA
| | - Theodore Quan
- Department of Orthopedic Surgery, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Irving Medical Center, 3959 Broadway, CHONY 8-N, New York, NY, 10032, USA
| | - Behrooz A Akbarnia
- Department of Orthopaedic Surgery, University of California San Diego, San Diego, CA, 92037, USA
| | | | - John M Flynn
- Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - David L Skaggs
- Department of Orthopaedics, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - John T Smith
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, 84113, USA
| | - Brian D Snyder
- Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA, 02115, USA
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, 02115, USA
| | - Paul D Sponseller
- Division of Pediatric Orthopaedics, Johns Hopkins University, Baltimore, MD, 21287, USA
| | - Richard E McCarthy
- Department of Orthopaedics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, AR, 72205, USA
| | - Peter F Sturm
- Department of Orthopedic Surgery, Cincinnati Children's Hospital, Cincinnati, OH, 45229, USA
| | - David P Roye
- Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA, 02115, USA
- Division of Pediatric Orthopaedic Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - John B Emans
- Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA, 02115, USA
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, 02115, USA
| | - Michael G Vitale
- Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA, 02115, USA
- Division of Pediatric Orthopaedic Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY, 10032, USA
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6
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Matsumoto H, Boby AZ, Sinha R, Campbell ML, Hung CW, Gbolo FC, Marciano GF, Levine S, Fano AN, Simhon ME, Quan T, Bainton NM, George A, Mizerik AS, Roye BD, Roye DP, Vitale MG. Development and Validation of a Health-Related Quality-of-Life Measure in Older Children and Adolescents with Early-Onset Scoliosis: Early-Onset Scoliosis Self-Report Questionnaire (EOSQ-SELF). J Bone Joint Surg Am 2022; 104:1393-1405. [PMID: 35726883 DOI: 10.2106/jbjs.21.01508] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The 24-question Early-Onset Scoliosis Questionnaire (EOSQ-24) is a proxy measure assessing health-related quality of life (HRQoL) among patients with early-onset scoliosis (EOS). There exists an increasing need to assess HRQoL through a child's own perspective, particularly for older children and adolescents with EOS. The purpose of this study was to develop and validate a self-reported questionnaire, the Early-Onset Scoliosis Self-Report Questionnaire (EOSQ-SELF), to assess HRQoL in older children and adolescents with EOS. METHODS A literature review, an expert focus group, and patient interviews were used to generate a preliminary survey of appropriate domains and question items. This survey was provided to English-speaking patients with EOS who were 8 to 18 years of age and capable of answering survey questions. Content validity was assessed for clarity and relevance of questions. Confirmatory factors analysis was performed to reduce the number of items and determine domains that fit items. Reliability was evaluated by measuring the internal consistency of items and test-retest reliability. Construct validity was evaluated by convergent, discriminant, and known-group validity. RESULTS The literature review, expert focus group, and patient interviews identified 59 questions in 14 domains. Psychometric analysis reduced these to 30 questions across 12 domains: General Health, Pain/Discomfort, Pulmonary Function, Transfer, Physical Function/Daily Living, Participation, Fatigue/Energy Level, Sleep, Appearance, Relationships, Emotion, and Satisfaction. The final questionnaire was found to have good content and construct validity and adequate reliability. CONCLUSIONS The EOSQ-SELF is a valid and reliable instrument for measuring self-reported HRQoL among older children and adolescents with EOS (ages 8 to 18 years). This will serve as an important research outcome measure and enhance clinical care by providing a better understanding of HRQoL for these patients. LEVEL OF EVIDENCE Diagnostic Level II . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Hiroko Matsumoto
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Afrain Z Boby
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY
| | - Rishi Sinha
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY
| | - Megan L Campbell
- Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah
| | - Chun Wai Hung
- Department of Orthopedic Surgery, Baylor College of Medicine, Houston, Texas
| | - Fay C Gbolo
- Center for Liver Disease and Transplantation, Department of Surgery, Columbia University Irving Medical Center, New York, NY
| | - Gerard F Marciano
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY
| | - Sonya Levine
- Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Adam N Fano
- Rutgers New Jersey Medical School, Newark, New Jersey
| | - Matthew E Simhon
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY
| | - Theodore Quan
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY
| | - Nicole M Bainton
- Division of Pediatric Orthopaedic Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY
| | - Ameeka George
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY
| | - Amber S Mizerik
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY
| | - Benjamin D Roye
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY.,Division of Pediatric Orthopaedic Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY
| | - David P Roye
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY
| | - Michael G Vitale
- Department of Orthopedic Surgery, Columbia University Irving Medical Center, New York, NY.,Division of Pediatric Orthopaedic Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY
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7
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Matsumoto H, Fano AN, Ball J, Roye BD, George A, Garg S, Erickson M, Samdani A, Skaggs D, Roye DP, Vitale MG. Uncorrected Pelvic Obliquity Is Associated With Worse Health-related Quality of Life (HRQoL) in Children and Their Caregivers at the End of Surgical Treatment for Early Onset Scoliosis (EOS). J Pediatr Orthop 2022; 42:e390-e396. [PMID: 35142714 DOI: 10.1097/bpo.0000000000002096] [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: 02/07/2023]
Abstract
BACKGROUND While largely of concern in nonambulatory patients, pelvic obliquity (PO) can be found in many patients with early onset scoliosis (EOS) and may remain following surgery. However, its association with health-related quality of life (HRQoL) in children and their caregivers at the end of treatment is not well understood. The purpose of this study was to investigate the association between residual PO and HRQoL in children and their caregivers at the end of surgical treatment in ambulatory patients with EOS. METHODS In this retrospective cohort study, a multicenter EOS registry was queried to identify ambulatory patients who underwent definitive posterior spinal fusion (PSF) from 2012 to 2019. Patients with fusions extending to the pelvis were excluded. PO was measured at least 1 year following PSF. HRQoL, Parental Burden, Financial Burden, and Satisfaction were assessed through the 24-Item Early Onset Scoliosis Questionnaire (EOSQ-24) also at a minimum of 1 year following PSF. RESULTS A total of 155 patients (12.5±2.1 y, 73.5% female) were included. Etiology distribution was 30.3% congenital, 12.9% neuromuscular, 21.3% syndromic, and 35.5% idiopathic. In congenital patients, those with residual PO >8 degrees had worse Satisfaction by 23.2 points compared with those with PO ≤8 degrees. In neuromuscular patients, those with residual PO >7 degrees had worse HRQoL by 16.1 points and Parental Burden by 22.3 points compared with their counterparts. In syndromic patients, those with residual PO >8 degrees had worse HRQoL by 14.8 points, Parental Burden by 16.4 points, and Satisfaction by 21.2 points compared with their counterparts. In idiopathic patients, those with >9 degrees of residual PO had worse HRQoL by 15.0 points and Financial Burden by 26.8 points compared with their counterparts. CONCLUSIONS Remaining PO at the end of surgical treatment is associated with worse HRQoL in ambulatory children and their caregivers. These results suggest that correction of PO should remain a primary goal of treatment in patients with EOS undergoing surgery. LEVEL OF EVIDENCE Level II-multicenter retrospective cohort study investigating prognosis.
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Affiliation(s)
- Hiroko Matsumoto
- Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center
- Department of Epidemiology, Columbia University Mailman School of Public Health
| | - Adam N Fano
- Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center
| | - Jacob Ball
- Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center
| | - Benjamin D Roye
- Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center
- New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | - Ameeka George
- New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | - Sumeet Garg
- Department of Orthopedic Surgery, Children's Hospital Colorado, Aurora, CO
| | - Mark Erickson
- Department of Orthopedic Surgery, Children's Hospital Colorado, Aurora, CO
| | - Amer Samdani
- Department of Neurosurgery, Shriners Hospital for Children, Philadelphia, PA
| | - David Skaggs
- Department of Orthopedic Surgery, Children's Hospital of Los Angeles, Los Angeles, CA
| | - David P Roye
- Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center
| | - Michael G Vitale
- Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center
- New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY
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8
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Matsumoto H, Larson EL, Warren SI, Hammoor BT, Bonsignore-Opp L, Troy MJ, Barrett KK, Striano BM, Li G, Terry MB, Roye BD, Lenke LG, Skaggs DL, Glotzbecker MP, Flynn JM, Roye DP, Vitale MG. A Clinical Risk Model for Surgical Site Infection Following Pediatric Spine Deformity Surgery. J Bone Joint Surg Am 2022; 104:364-375. [PMID: 34851324 DOI: 10.2106/jbjs.21.00751] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Despite tremendous efforts, the incidence of surgical site infection (SSI) following the surgical treatment of pediatric spinal deformity remains a concern. Although previous studies have reported some risk factors for SSI, these studies have been limited by not being able to investigate multiple risk factors at the same time. The aim of the present study was to evaluate a wide range of preoperative and intraoperative factors in predicting SSI and to develop and validate a prediction model that quantifies the risk of SSI for individual pediatric spinal deformity patients. METHODS Pediatric patients with spinal deformity who underwent primary, revision, or definitive spinal fusion at 1 of 7 institutions were included. Candidate predictors were known preoperatively and were not modifiable in most cases; these included 31 patient, 12 surgical, and 4 hospital factors. The Centers for Disease Control and Prevention definition of SSI within 90 days of surgery was utilized. Following multiple imputation and multicollinearity testing, predictor selection was conducted with use of logistic regression to develop multiple models. The data set was randomly split into training and testing sets, and fivefold cross-validation was performed to compare discrimination, calibration, and overfitting of each model and to determine the final model. A risk probability calculator and a mobile device application were developed from the model in order to calculate the probability of SSI in individual patients. RESULTS A total of 3,092 spinal deformity surgeries were included, in which there were 132 cases of SSI (4.3%). The final model achieved adequate discrimination (area under the receiver operating characteristic curve: 0.76), as well as calibration and no overfitting. Predictors included in the model were nonambulatory status, neuromuscular etiology, pelvic instrumentation, procedure time ≥7 hours, American Society of Anesthesiologists grade >2, revision procedure, hospital spine surgical cases <100/year, abnormal hemoglobin level, and overweight or obese body mass index. CONCLUSIONS The risk probability calculator encompassing patient, surgical, and hospital factors developed in the present study predicts the probability of 90-day SSI in pediatric spinal deformity surgery. This validated calculator can be utilized to improve informed consent and shared decision-making and may allow the deployment of additional resources and strategies selectively in high-risk patients. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Hiroko Matsumoto
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Elaine L Larson
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY.,School of Nursing, Columbia University Irving Medical Center, New York, NY
| | - Shay I Warren
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California
| | - Bradley T Hammoor
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY
| | - Lisa Bonsignore-Opp
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY
| | - Michael J Troy
- Department of Orthopedic Surgery, Harvard Medical School, Boston, Massachusetts
| | - Kody K Barrett
- Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, California
| | - Brendan M Striano
- Department of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Gen Li
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Mary Beth Terry
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Benjamin D Roye
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY
| | - Lawrence G Lenke
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY
| | - David L Skaggs
- Spine Center, Cedars-Sinai Medical Center, Los Angeles, California
| | - Michael P Glotzbecker
- Department of Orthopaedic Surgery, Rainbow Babies and Children's Hospital, University Hospital Cleveland Medical Center, Cleveland, Ohio
| | - John M Flynn
- Department of Orthopaedic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - David P Roye
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY
| | - Michael G Vitale
- Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY
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May HJ, Fasheun JA, Bain JM, Baugh EH, Bier LE, Revah-Politi A, Roye DP, Goldstein DB, Carmel JB. Genetic testing in individuals with cerebral palsy. Dev Med Child Neurol 2021; 63:1448-1455. [PMID: 34114234 PMCID: PMC9277698 DOI: 10.1111/dmcn.14948] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/30/2021] [Indexed: 12/28/2022]
Abstract
AIM To determine which patients with cerebral palsy (CP) should undergo genetic testing, we compared the rate of likely causative genetic variants from whole-exome sequencing in individuals with and without environmental risk factors. METHOD Patients were part of a convenience and physician-referred cohort recruited from a single medical center, and research whole-exome sequencing was completed. Participants were evaluated for the following risk factors: extreme preterm birth, brain bleed or stroke, birth asphyxia, brain malformations, and intrauterine infection. RESULTS A total of 151 unrelated individuals with CP (81 females, 70 males; mean age 25y 7mo [SD 17y 5mo], range 3wks-72y) participated. Causative genetic variants were identified in 14 participants (9.3%). There was no significant difference in diagnostic rate between individuals with risk factors (10 out of 123; 8.1%) and those without (4 out of 28; 14.3%) (Fisher's exact p=0.3). INTERPRETATION While the rate of genetic diagnoses among individuals without risk factors was higher than those with risk factors, the difference was not statistically significant at this sample size. The identification of genetic diagnoses in over 8% of cases with risk factors suggests that these might confer susceptibility to environmental factors, and that further research should include individuals with risk factors. What this paper adds There is no significant difference in diagnostic rate between individuals with and without risk factors. Genetic variants may confer susceptibility to environmental risk factors. Six causative variants were identified in genes not previously associated with cerebral palsy. Global developmental delay/intellectual disability is positively associated with a genetic etiology. Extreme preterm birth, stroke/brain hemorrhage, and older age are negatively associated with a genetic etiology.
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Affiliation(s)
- Halie J. May
- Institute for Genomic Medicine, Columbia University Irving Medical Center, New York, NY
| | - Jennifer A. Fasheun
- Weinberg Family Cerebral Palsy Center, Department of Orthopedics, Columbia University Irving Medical Center, New York, NY
| | - Jennifer M. Bain
- Department of Neurology, Columbia University Irving Medical Center, New York, NY
| | - Evan H. Baugh
- Institute for Genomic Medicine, Columbia University Irving Medical Center, New York, NY
| | - Louise E. Bier
- Institute for Genomic Medicine, Columbia University Irving Medical Center, New York, NY
| | - Anya Revah-Politi
- Institute for Genomic Medicine, Columbia University Irving Medical Center, New York, NY,Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY
| | - David P. Roye
- Weinberg Family Cerebral Palsy Center, Department of Orthopedics, Columbia University Irving Medical Center, New York, NY
| | - David B. Goldstein
- Institute for Genomic Medicine, Columbia University Irving Medical Center, New York, NY
| | - Jason B. Carmel
- Weinberg Family Cerebral Palsy Center, Department of Orthopedics, Columbia University Irving Medical Center, New York, NY,Department of Neurology, Columbia University Irving Medical Center, New York, NY
| | - NYP/CUIMC Genomics Team
- Institute for Genomic Medicine, Columbia University Irving Medical Center, New York, NY,Weinberg Family Cerebral Palsy Center, Department of Orthopedics, Columbia University Irving Medical Center, New York, NY,Department of Neurology, Columbia University Irving Medical Center, New York, NY,Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, NY,Division of Clinical Genetics, Department of Pediatrics, Columbia University Irving Medical Center, New York, NY
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10
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Simhon ME, Fields MW, Grimes KE, Bakarania P, Matsumoto H, Boby AZ, Berdishevsky H, Roye BD, Roye DP, Vitale MG. Completion of a formal physiotherapeutic scoliosis-specific exercise training program for adolescent idiopathic scoliosis increases patient compliance to home exercise programs. Spine Deform 2021; 9:691-696. [PMID: 33230667 DOI: 10.1007/s43390-020-00253-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 11/03/2020] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Physiotherapeutic Scoliosis-Specific Exercise (PSSE) is a conservative approach for management of adolescent idiopathic scoliosis (AIS). Although there is Level I evidence for the efficacy of PSSE, compliance in the teenage population remains in question. The purpose of this study is to investigate the association between completion of formal PSSE training and compliance to prescribed home exercise programs (HEP). METHODS Patients with AIS evaluated at our institution between 2013 and 2015 with a minimum of one PSSE session were enrolled. A chart review and questionnaire completed by caregivers was utilized to assess HEP compliance following the final PSSE session at 1 week, 3 months, 1 year, and 2 years. Patients were divided into two groups, those completing formal training (10 or more PSSE sessions), and those who did not complete formal training (fewer than 10 sessions). RESULTS 81 patients were identified (mean age of 13.1 years; major curve of 31.3°). Patients who completed training demonstrated 50% compliance at 1 week (vs. 25.6% for non-completers, Odds Ratio (OR): 2.9, p = 0.027), 41.2% at 3 months (vs. 18.9% for non-completers, OR: 3.0, p = 0.044), 23.5% at 1 year (vs. 13.5% for non-completers, OR: 2.0, p = 0.281), and 25.7% at 2 years (vs. 13.5% for non-completers, OR: 2.2, p = 0.197). The mean HEP duration (minutes) in patients who completed training was higher at 1 week (80.8 vs. 48, p = 0.010), 3 months (64.6 vs. 23.7, p ≤ 0.001), 1 year (35.3 vs. 22.7, p = 0.270), and 2 years (34.3 vs. 18.9, p = 0.140). CONCLUSION Patients who completed PSSE training maintained higher HEP compliance.
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Affiliation(s)
- Matthew E Simhon
- Columbia University Medical Center, 3959 Broadway-8 North, New York, NY, 10032, USA
| | - Michael W Fields
- Columbia University Medical Center, 3959 Broadway-8 North, New York, NY, 10032, USA
| | - Kelly E Grimes
- Columbia University Medical Center, 3959 Broadway-8 North, New York, NY, 10032, USA
| | - Prachi Bakarania
- Columbia University Medical Center, 3959 Broadway-8 North, New York, NY, 10032, USA
| | - Hiroko Matsumoto
- Columbia University Medical Center, 3959 Broadway-8 North, New York, NY, 10032, USA.
| | - Afrain Z Boby
- Columbia University Medical Center, 3959 Broadway-8 North, New York, NY, 10032, USA
| | - Hagit Berdishevsky
- Columbia University Medical Center, 3959 Broadway-8 North, New York, NY, 10032, USA
| | - Benjamin D Roye
- Columbia University Medical Center, 3959 Broadway-8 North, New York, NY, 10032, USA
| | - David P Roye
- Columbia University Medical Center, 3959 Broadway-8 North, New York, NY, 10032, USA
| | - Michael G Vitale
- Columbia University Medical Center, 3959 Broadway-8 North, New York, NY, 10032, USA
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11
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Matsumoto H, Fields MW, Roye BD, Roye DP, Skaggs D, Akbarnia BA, Vitale MG. Complications in the treatment of EOS: Is there a difference between rib vs. spine-based proximal anchors? Spine Deform 2021; 9:247-253. [PMID: 32955696 DOI: 10.1007/s43390-020-00200-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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] [Received: 04/02/2020] [Accepted: 08/29/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Currently, there is significant equipoise regarding the selection and placement of growing spinal instrumentation when treating patients with early-onset scoliosis (EOS). The primary purpose of this study was to compare complications following surgery in patients receiving rib-based versus spine-based proximal anchors as a part of posterior growing instrumentation in the management of EOS. METHODS Retrospective cohort study. Inclusion criteria required: age 3-10 years old, diagnosis of EOS, treatment with a growing construct that utilized rib- or spine-based proximal anchors, and a major coronal curve larger than 40 degrees. The primary outcome analyzed was postoperative complications. Secondary outcomes included coronal major curve correction and patient reported outcomes measured by the Early-Onset Scoliosis 24-item Questionnaire (EOSQ-24). Subjects were categorized into rib- or spine-based proximal fixation groups for comparison. RESULTS Of 104 patients included in the study, 76 (73.1%) were treated with rib-based constructs and 28 (26.9%) were treated with spine-based constructs. 24 (31.6%) patients with rib-based constructs and 9 (32.1%) patients with spine-based constructs experienced at least one implant related complication (p = 0.956). Rod fracture was observed more often in spine-based groups than rib-based groups for both patients with congenital/idiopathic EOS (rib: 0 (0%) vs. spine: 3 (13.6%), p = 0.009) and neuromuscular/syndromic EOS (rib: 0 (0%) vs. spine: 2 (33.3%), p = 0.002). Furthermore, surgical site infection was found to be more frequent in rib-based than spine-based groups for neuromuscular/syndromic patients (rib: (13) 27.15 vs. spine: (1) 4.5%, p = 0.029). The most commonly reported complication was device migration. In patients with rib-based constructs, 2 (12.5%) patients with ≥ 5 anchors and 13 (21.7%) patients with < 5 anchors experienced device migration (p = 0.413). In patients with spine-based constructs, 1 (11.1%) patient with ≥ 5 anchors and 4 (21.1%) patients with < 5 anchors experienced device migration (p = 0.064). Spine-based anchors had significantly higher% correction (42.0%) compared to rib-based anchors (20.6%) (p = 0.003) at the most recent follow-up. There were no significant differences in the change of patient reported outcomes as measured by the EOSQ-24 between patients who received rib or spine-based anchors. DISCUSSION The number of patients with at least one implant related complication was similar between the rib- and spine-based groups. Having 5 or more proximal anchors appeared protective against proximal device migration; however, this result was not statistically significant. Spine-based anchors had better overall correction than rib-based anchors. There were no differences in the change in patient reported outcomes between spine- and rib-based cohorts.
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Affiliation(s)
- Hiroko Matsumoto
- Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY, 10032, USA.
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA.
| | - Michael W Fields
- Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - Benjamin D Roye
- Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - David P Roye
- Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY, 10032, USA
| | - David Skaggs
- Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Behrooz A Akbarnia
- Department of Orthopaedic Surgery, University of California, San Diego, San Diego, CA, USA
| | - Michael G Vitale
- Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Irving Medical Center, New York, NY, 10032, USA
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12
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Matsumoto H, Mueller J, Konigsberg M, Ball J, St Hilaire T, Pawelek J, Roye DP, Cahill P, Sturm P, Smith J, Thompson G, Sponseller P, Skaggs D, Vitale MG. Improvement of Pulmonary Function Measured by Patient-reported Outcomes in Patients With Spinal Muscular Atrophy After Growth-friendly Instrumentation. J Pediatr Orthop 2021; 41:1-5. [PMID: 32804864 DOI: 10.1097/bpo.0000000000001656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 02/07/2023]
Abstract
BACKGROUND Children with spinal muscular atrophy (SMA) sustain a progressive reduction in pulmonary function (PF) related to both muscular weakness and the concomitant effects of spinal deformity on the thorax. Growth-friendly instrumentation is commonly utilized for younger patients with scoliosis and SMA to halt the progression of spinal curvature, but its effect on PF in these patients has not previously been investigated. Using the change in Early Onset Scoliosis 24-Item Questionnaire (EOSQ-24) PF subdomain scores, the authors will investigate whether PF improves in patients with SMA after a growth-friendly intervention. METHODS This was a multicenter retrospective cohort study from 2 international registries of patients with SMA undergoing spinal deformity surgery from 2005 to 2015. Data collected were age, sex, degree of major coronal curve, type of growth-friendly construct, forced vital capacity (FVC), and EOSQ-24 scores at the patient's preoperative, 1-year postoperative, and 2-year postoperative visits. Differences in EOSQ-24 PF scores and FVC between baseline and postoperative assessment were examined by paired tests. RESULTS A total of 74 patients were identified (mean age, 7.6±2.3 y, major curve 68.1±22.4 degrees, 51.4% female individuals). The mean EOSQ-24 PF scores improved significantly from 70.6 preoperatively to 83.6 at 1 year (P=0.092) and 86.5 at 2 years postoperatively (P=0.020). The scores in patients with rib-based constructs showed steeper increases at 1-year assessments than those in patients with spine-based constructs. The mean paired FVC value decreased from 63.9% predicted preoperatively, to 57.6% predicted at 1 year postoperatively (P=0.035), and 61.9% predicted preoperatively, to 56.3% predicted at 2 years postoperatively (P=0.178). CONCLUSIONS Patients with SMA who received growth-friendly instrumentation did experience improvements in PF as measured by EOSQ-24 assessing the caregivers' perception. Given the uncertain reliability of PFTs in this young population, EOSQ-24 is an important tool for measuring improvements in health-related quality of life. LEVEL OF EVIDENCE Level III-retrospective study.
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Affiliation(s)
- Hiroko Matsumoto
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY
| | - John Mueller
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY
| | - Matthew Konigsberg
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY
| | - Jacob Ball
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY
| | | | | | - David P Roye
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY
| | - Patrick Cahill
- Department of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Peter Sturm
- Department of Orthopedic Surgery, Cincinnati Children's Hospital, Cincinnati
| | - John Smith
- Department of Orthopedic Surgery, Primary Children's Hospital, Salt Lake City, UT
| | - George Thompson
- Department of Orthopedic Surgery, Rainbow Babies and Children's Hospital, Cleveland, OH
| | - Paul Sponseller
- Department of Orthopedic Surgery, The Johns Hopkins Hospital, Baltimore, MD
| | - David Skaggs
- Department of Orthopedic Surgery, Children's Hospital of Los Angeles, Los Angeles, CA
| | - Michael G Vitale
- Department of Orthopedic Surgery, Columbia University Medical Center, New York, NY
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Ball JR, Konigsberg MW, Plachta S, Fields MW, Matsumoto H, Roye BD, Arora S, Roye DP, Lenke LG, Skaggs DL, Vitale MG. Variability in stable sagittal vertebra (SSV) during full-length biplanar xrays can affect the choice of fusion levels in patients with adolescent idiopathic scoliosis (AIS). Spine Deform 2020; 8:1261-1267. [PMID: 32666471 DOI: 10.1007/s43390-020-00166-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 06/30/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE Surgical planning for Adolescent Idiopathic Scoliosis (AIS) relies on the coronal and sagittal plane to determine the lowest instrumented vertebra (LIV). Failure to include the stable sagittal vertebra (SSV) within the construct can increase the incidence of postoperative distal junctional kyphosis (DJK). The purpose of this study is to assess the variability of SSV within patients and to identify positional parameters that may lead to its change. METHODS This is a case-control study of AIS patients with changes in SSV throughout serial radiographs. Radiographic sagittal parameters and hand positioning for the patients with changes in SSV were compared to patients with stable SSV. Additionally, a subgroup analysis was conducted to compare the positional parameters of only the patients with changes in SSV. RESULTS 46 patients with a mean age of 15 ± 1.8 years old at the time of surgery were included in this study. 33/76 (43.4%) image pairs were found to have a change in SSV. Positional parameters associated with the more distally measured SSV were found to have a more negative sagittal vertebral axis (p = 0.001), more positive pelvic shift (p = 0.023), and more negative Global Sagittal Axis (p = 0.001) when compared to the more proximally measured SSV. CONCLUSION Significant variability exists in the determination of SSV in AIS patients undergoing serial radiographs. Positional parameters associated with the proximal and distally measured SSV also have variability which indicates that posture has a significant impact on this measure. Surgeons need to be aware of SSV variability during preoperative planning and must consider multiple parameters for the determination of LIV. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- Jacob R Ball
- Department of Pediatric Orthopaedic Surgery, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Medical Center, ATTN: Michael Vitale, 3959 Broadway, CHONY 8-N, New York, NY, 10032-3784, USA
| | - Matthew W Konigsberg
- Department of Pediatric Orthopaedic Surgery, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Medical Center, ATTN: Michael Vitale, 3959 Broadway, CHONY 8-N, New York, NY, 10032-3784, USA
| | - Stephen Plachta
- Department of Pediatric Orthopaedic Surgery, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Medical Center, ATTN: Michael Vitale, 3959 Broadway, CHONY 8-N, New York, NY, 10032-3784, USA
| | - Michael W Fields
- Department of Pediatric Orthopaedic Surgery, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Medical Center, ATTN: Michael Vitale, 3959 Broadway, CHONY 8-N, New York, NY, 10032-3784, USA
| | - Hiroko Matsumoto
- Department of Pediatric Orthopaedic Surgery, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Medical Center, ATTN: Michael Vitale, 3959 Broadway, CHONY 8-N, New York, NY, 10032-3784, USA
| | - Benjamin D Roye
- Department of Pediatric Orthopaedic Surgery, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Medical Center, ATTN: Michael Vitale, 3959 Broadway, CHONY 8-N, New York, NY, 10032-3784, USA
| | - Sushrut Arora
- Department of Pediatric Orthopaedic Surgery, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Medical Center, ATTN: Michael Vitale, 3959 Broadway, CHONY 8-N, New York, NY, 10032-3784, USA
| | - David P Roye
- Department of Pediatric Orthopaedic Surgery, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Medical Center, ATTN: Michael Vitale, 3959 Broadway, CHONY 8-N, New York, NY, 10032-3784, USA
| | - Lawrence G Lenke
- Department of Pediatric Orthopaedic Surgery, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Medical Center, ATTN: Michael Vitale, 3959 Broadway, CHONY 8-N, New York, NY, 10032-3784, USA
| | - David L Skaggs
- Department of Orthopedic Surgery, Children's Hospital of Los Angeles, Los Angeles, CA, USA
| | - Michael G Vitale
- Department of Pediatric Orthopaedic Surgery, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Medical Center, ATTN: Michael Vitale, 3959 Broadway, CHONY 8-N, New York, NY, 10032-3784, USA.
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14
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Hung CW, Matsumoto H, Ball JR, Plachta S, Dutkowsky JP, Kim H, Hyman JE, Riew KD, Roye DP. Symptomatic cervical spinal stenosis in spastic cerebral palsy. Dev Med Child Neurol 2020; 62:1147-1153. [PMID: 32639039 DOI: 10.1111/dmcn.14607] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 05/08/2020] [Accepted: 05/12/2020] [Indexed: 12/30/2022]
Abstract
AIM To describe the prevalence of symptomatic cervical spinal stenosis (CSS) in spastic cerebral palsy (CP) and associated characteristics. METHOD This cross-sectional study of adults (>18y) with CP (2006-2016) at a single institution compared the patient characteristics (demographics, comorbidities, surgical history, medications, Gross Motor Function Classification System [GMFCS] level, and CP type) of patients with and without CSS. RESULTS Of 424 patients (mean age 33y 4mo, SD 13y 6mo, range 18-78y; 225 females, 199 males), 32 patients (7.5%) had symptomatic CSS. GMFCS levels in the study cohort were distributed as follows: level I, 25%; level II, 25%; level III, 22%; level IV, 19%; level V, 9%. Twenty-five out of 32 (78.1%) patients had spastic CP, two (6.3%) had dystonic CP, and one (3.1%) had mixed characteristics. Individuals with CSS were older (mean age 54y 6mo, SD 10y 5mo vs mean age 31y 7mo, SD 12y 1mo, p<0.05) and had a higher body mass index (26.1, SD 4.8 vs 23.4, SD 6.2, p<0.05) than those without CSS. Presentations included upper-extremity symptoms (73%), ambulation decline (70%), neck pain (53%), and incontinence (30%). Common stenosis levels were C5-C6 (59%), C4-C5 (56%), and C6-C7 (53%). INTERPRETATION Symptomatic CSS was identified in 7.5% of this adult cohort during the 2006 to 2016 period. Diagnosis in CP is difficult due to impaired communication and pre-existing gait abnormalities and spasticity. Given the high prevalence of symptomatic CSS in adults, we propose developing screening guidelines. Physicians must maintain a high level of suspicion for CSS if patients present with changes in gait or spasticity.
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Affiliation(s)
- Chun Wai Hung
- Weinberg Family Cerebral Palsy Center, Columbia University Medical Center, New York, NY, USA.,Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Hiroko Matsumoto
- Weinberg Family Cerebral Palsy Center, Columbia University Medical Center, New York, NY, USA.,Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY
| | - Jacob R Ball
- Weinberg Family Cerebral Palsy Center, Columbia University Medical Center, New York, NY, USA.,Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Stephen Plachta
- Weinberg Family Cerebral Palsy Center, Columbia University Medical Center, New York, NY, USA.,Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Joseph P Dutkowsky
- Weinberg Family Cerebral Palsy Center, Columbia University Medical Center, New York, NY, USA.,Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Heakyung Kim
- Weinberg Family Cerebral Palsy Center, Columbia University Medical Center, New York, NY, USA.,Department of Rehabilitation and Regenerative Medicine, Columbia University Medical Center, New York, NY, USA
| | - Joshua E Hyman
- Weinberg Family Cerebral Palsy Center, Columbia University Medical Center, New York, NY, USA.,Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - K Daniel Riew
- Department of Orthopedic Surgery, Columbia University, The Spine Hospital at NY-Presbyterian/Allen Hospital, New York, NY, USA
| | - David P Roye
- Weinberg Family Cerebral Palsy Center, Columbia University Medical Center, New York, NY, USA.,Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
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15
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Matsumoto H, Warren S, Simhon ME, Konigsberg MW, Fields MW, Roye BD, Roye DP, Vitale MG. It is not just about the frontal plane: sagittal parameters impact curve progression in AIS patients undergoing brace treatment. Spine Deform 2020; 8:921-929. [PMID: 32338342 DOI: 10.1007/s43390-020-00122-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 04/11/2020] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES The purpose of this study was to explore the association between pre-brace and in-brace sagittal parameters and curve progression. To date, there has been no published research focused on spinopelvic sagittal parameters and bracing outcomes in AIS. We hypothesize that sagittal spinopelvic parameters are associated with curve progression at 2 years. METHODS This study included AIS patients with a pre-brace (PB) major curve between 20° and 45°. The outcome was defined as > 10° curve progression or surgery within 2 years of brace initiation. Spinopelvic parameters included C7-Central Sacral Vertebral Line shift (C7-CSVL), thoracic trunk shift, lumbar lordosis (LL), pelvic incidence (PI), T2-T12 thoracic kyphosis (TK) pelvic incidence-lumbar lordosis (PI-LL) mismatch, sagittal vertical axis (SVA), and pelvic tilt (PT). RESULTS Of 50 patients included in this review, [70% Rigo (RCSO) and 30% Boston (BSO)], 16 (32%) patients demonstrated progression (23% of patients with RCSO vs 53% with BSO; p = 0.034). In patients with more than 30% major coronal curve correction (CCC), 23% had progression. 45% of patients progressed when they achieved ≤ 30% correction (p = 0.108). Among PB sagittal parameters and adjusting for coronal curve, patients with an abnormal PB SVA had 3.1 times increased risk of treatment failure compared with patients who had a normal PB SVA. Patients with PB hypo-LL had a 2.8 times increased risk of treatment failure compared with patients who had normal or hyper-LL. Among IB sagittal parameters, patients who had a normal PB PI-LL had a 3.9 times increased risk of treatment failure when they became mismatched in-brace (IB). Patients who had normal pre-brace kyphosis who became hypo-kyphotic IB had an 8.4 times increased risk of treatment failure compared with patients who maintained normal TK or became hyper-kyphotic. CONCLUSION These data suggest that we should pay careful attention to sagittal parameters prior to and during brace treatment as braces can control these parameters. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Hiroko Matsumoto
- Department of Pediatric Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA.
- Department of Pediatric Orthopaedic Surgery, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Medical Center, ATTN: Hiroko Matsumoto, 3959 Broadway, CHONY 8-N, New York, NY, 10032-3784, USA.
| | - Shay Warren
- Department of Pediatric Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Matthew E Simhon
- Department of Pediatric Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Matthew W Konigsberg
- Department of Pediatric Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Michael W Fields
- Department of Pediatric Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Benjamin D Roye
- Department of Pediatric Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - David P Roye
- Department of Pediatric Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Michael G Vitale
- Department of Pediatric Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
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16
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Li Z, Yue Y, Matsumoto H, Vitale MG, Roye DP, Song X, Xu N. Reliability and validity of the simplified Chinese version of the Early Onset Scoliosis-24-Item Questionnaire (EOSQ-24). Transl Pediatr 2020; 9:513-521. [PMID: 32953549 PMCID: PMC7475316 DOI: 10.21037/tp-19-177] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND It is important to use standard assessment tools to quantify the impact of early-onset scoliosis (EOS) on the health-related quality of life of these children and their caregivers. In this study we aimed to translate and validate the simplified Chinese version of the Early Onset Scoliosis Questionnaire-24 (EOSQ-24) in order to assess the health-related quality of life (HRQoL) and caregiver burden among patients with EOS from mainland China. METHODS EOSQ-24 was forward-and-backward translated according to standard protocols, culturally adapted, and administered to patients fulfilling specific inclusion criteria and recruited between February and December 2015. Response distribution was assessed by their median and standard deviation. Floor and ceiling effects were calculated. Reliability was established using Cronbach's α and discriminative validity was determined using the Mann-Whitney U test and the Kruskal-Wallis test. RESULTS A total of 63 children and their parents participated in this study. Most responses were left skewed towards normal physical and psychosocial well-being. No floor effect was observed but ceiling effect was found in questions regarding pain and pulmonary function. Cronbach's α for all questions and all domains was 0.950, and 0.927, respectively. EOSQ-24 scores were negatively correlated with curve severity and ambulatory status. Based on these preliminary results, EOSQ-24 could be used to distinguish patients in these regards. CONCLUSIONS The simplified Chinese version of EOSQ-24 is a reliable and valid tool for HRQoL assessment among caregivers (parents) of children with EOS in mainland China. It could potentially be incorporated into routine clinical care in this patient population and as a standard assessment tool for research purposes.
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Affiliation(s)
- Zhehuang Li
- Department of Orthopaedics, Peking University Third Hospital, 49 Huayuan North Road, Beijing, China
| | - Yu Yue
- Department of Pediatric Orthopaedic, Zhengzhou Orthopaedic Hospital, Zhengzhou, China
| | - Hiroko Matsumoto
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Michael G Vitale
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - David P Roye
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Xiangjian Song
- Department of Pediatric Orthopaedic, Zhengzhou Orthopaedic Hospital, Zhengzhou, China
| | - Nanfang Xu
- Department of Orthopaedics, Peking University Third Hospital, 49 Huayuan North Road, Beijing, China
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Xu N, Matsumoto H, Hyman J, Roye B, Kim H, Roye DP. Evaluation of assessment of caregiver experience with neuromuscular disease: reliability and responsiveness of a new caregiver-reported outcome measure in patients with cerebral palsy. Transl Pediatr 2020; 9:507-512. [PMID: 32953548 PMCID: PMC7475311 DOI: 10.21037/tp-19-176] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Cerebral palsy (CP) is the most common cause of chronic childhood disability. Caregivers often provide prolonged care over patients' life span, thus measuring the impact of the disease and its treatments on caregivers has become a recent focus in research. The current study aims to present an evaluation of the reliability and responsiveness of assessment of caregiver experience with neuromuscular disease (ACEND) following botulinum toxin injection to relieve spasticity in children with CP. METHODS Patients with baseline ACEND scores and at least one assessment following botulinum toxin injection were enrolled. Data on their gender, age, diagnoses, and functional levels (according to The Gross Motor Function Classification System, GMFCS), and ACEND scores were analyzed. Statistical analyses performed included paired t-test and linear regression. RESULTS Baseline ACEND scores (117.7±47.7) were strongly correlated with follow-up scores (120.4±49.5) with a coefficient of 0.929 (P<0.001), suggesting the high reliability of the questionnaire. Paired-sample t-test revealed an insignificant average improvement in ACEND of 2.7 (P=0.352). The ICD-10 code and the GMFCS level were found to be significant predictors for baseline (P=0.043, P<0.001) and follow-up ACEND scores (P=0.025, P<0.001). Male gender was a significant predictor for improvement in ACEND scores. CONCLUSIONS We demonstrated the reliability of ACEND through strong correlations of scores before and after botulinum toxin injection. In terms of responsiveness, while the burden of care is largely determined by ICD-10 diagnosis and the GMFCS level, changes in care burden are only related to the gender of the patient and the follow-up time interval.
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Affiliation(s)
- Nanfang Xu
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
| | - Hiroko Matsumoto
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Joshua Hyman
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Benjamin Roye
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Heakyung Kim
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - David P Roye
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA.,JuniperMD, New York, NY, USA
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Park JH, Stegall PR, Roye DP, Agrawal SK. Robotic Spine Exoskeleton (RoSE): Characterizing the 3-D Stiffness of the Human Torso in the Treatment of Spine Deformity. IEEE Trans Neural Syst Rehabil Eng 2019; 26:1026-1035. [PMID: 29752238 DOI: 10.1109/tnsre.2018.2821652] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Spine deformity is typically treated with a brace that fits around the torso and hips to correct the abnormal curve of the spine. While bracing has been shown to curtail progression of abnormal spine curves, current braces impose several limitations due to their rigid, static, and sensor-less designs: (1) forces and moments exerted by the brace cannot be measured or modulated and (2) the 3-D stiffness of the human torso has not been characterized-these may be important factors to be considered in bracing treatment. We address these limitations using a robotic spine exoskeleton (RoSE), capable of controlling the position/orientation of specific cross sections of the human torso while simultaneously measuring the forces/moments exerted on the body. Eight healthy subjects and two subjects with spine deformity participated in a study to characterize the 3-D stiffness of their torso. The results show that the 3-D stiffness of human torso can be characterized using RoSE and indicated that the spine deformities induce torso stiffness characteristics significantly different from the healthy subjects. These characteristics are curve-specific and present a pronounced asymmetry. These results open up the possibility for the design of spine braces incorporating patient specific torso stiffness characteristics and potential for new interventions using the dynamic modulation of 3-D forces for spine deformity treatment.
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Baranek ES, Maier SP, Matsumoto H, Hyman JE, Vitale MG, Roye DP, Roye BD. Gross Motor Function Classification System Specific Growth Charts-Utility as a Risk Stratification Tool for Surgical Site Infection Following Spine Surgery. J Pediatr Orthop 2019; 39:e298-e302. [PMID: 30839482 DOI: 10.1097/bpo.0000000000001285] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is currently minimal evidence that preoperative malnutrition increases surgical site infection (SSI) risk in children with cerebral palsy (CP) undergoing spinal deformity surgery. Growth charts specifically for patients with CP have been created to aid in the clinical interpretation of body mass index (BMI) as a marker of nutritional status, but to our knowledge these charts have never been used to risk stratify patients before orthopaedic surgery. We hypothesize that patients with CP who have BMI-for-age below the 10th percentile (BMI≤10) on CP-specific growth charts are at increased risk of surgical site infection following spinal deformity surgery compared with patients with BMI-for-age above the 10th percentile (BMI>10). METHODS Single-center, retrospective review comparing the rate of SSI in patients with CP stratified by BMI-for-age percentiles on CP-specific growth charts who underwent spinal deformity surgery. Odds ratios with 95% confidence intervals and Pearson χ tests were used to analyze the association of the measured nutritional indicators with SSI. RESULTS In total, 65 patients, who underwent 74 procedures, had complete follow-up data and were included in this analysis. Ten patients (15.4%) were GMFCS I-III and 55 (84.6%) were GMFCS IV-V; 39 (60%) were orally fed and 26 (40%) were tube-fed. The rate of SSI in this patient population was 13.5% with 10 SSIs reported within 90 days of surgery. There was a significant association between patients with a BMI below the 10th percentile on GMFCS-stratified growth charts and the development of SSI (OR, 13.6; 95% CI, 2.4-75.4; P=0.005). All SSIs occurred in patients that were GMFCS IV-V. There was no association between height, weight, feeding method, or pelvic instrumentation and development of SSI. CONCLUSIONS CP-specific growth charts are useful tools for identifying patients at increased risk for SSI following spinal instrumentation procedures, whereas standard CDC growth charts are much less sensitive. There is a strong association between preoperative BMI percentile on GMFCS-stratified growth charts and SSI following spinal deformity surgery. LEVEL OF EVIDENCE Level III-Retrospective Study.
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Affiliation(s)
- Eric S Baranek
- Children's Hospital of New York, Columbia University Medical Center, New York, NY
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Feinberg N, Matsumoto H, Hung CW, St Hilaire T, Pawelek J, Sawyer JR, Akbarnia BA, Skaggs DL, Roye BD, Roye DP, Vitale MG. Expert Consensus and Equipoise: Planning a Randomized Controlled Trial of Magnetically Controlled Growing Rods. Spine Deform 2019; 6:303-307. [PMID: 29735141 DOI: 10.1016/j.jspd.2017.11.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 10/30/2017] [Accepted: 11/07/2017] [Indexed: 10/17/2022]
Abstract
STUDY DESIGN Expert consensus building using combined Delphi method and Nominal group technique. OBJECTIVES To identify the current state of equipoise surrounding the use of magnetically controlled growing rods (MCGRs) and to determine consensus for planning a randomized controlled trial (RCT) with MCGRs. BACKGROUND The use of MCGRs for the treatment of early-onset scoliosis (EOS) is a new technology. Optimal use has not been thoroughly investigated and much uncertainty exists. Areas of uncertainty include construct architecture, timing of lengthenings, and amount of distraction per lengthening. Expert discussion and consensus is useful at this early juncture and necessary when designing an RCT. METHODS Two rounds of surveys were administered to a group of experienced pediatric spine surgeons, followed by a 2-hour, face-to-face meeting in November 2015 and a 1-hour, face-to-face meeting in February 2016. The first survey used example cases to establish agreement around the proper use of MCGRs and identified areas of equipoise and disagreement. The second survey again used example cases-this time selected for their equipoise status-to solicit trial arms for a potential RCT of MCGRs and identified important open questions in the use of MCGRs. Lastly, the face-to-face meetings employed iterative voting to preliminarily plan an RCT of MCGRs. RESULTS Following the Delphi survey rounds and the two Nominal face-to-face meetings, the group of experts decided on an MCGR RCT design that standardized all patients to bidirectional constructs, and randomized to a lengthening interval of 6 versus 16 weeks with a standardized equation for calculating the total yearly lengthening that approximates normal spine growth. CONCLUSION This endeavor indicates expert support for the use of MCGR in children older than 6 years, with curves greater than 60°. The uncertainty surrounding frequency of lengthening justifies an RCT of MCGRs. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
- Nicholas Feinberg
- Columbia University Medical Center, 3959 Broadway, 8 North, New York, NY 10032, USA
| | - Hiroko Matsumoto
- Growing Spine Foundation, 555 E Wells St, Milwaukee, WI 53202, USA.
| | - Chun Wai Hung
- Columbia University Medical Center, 3959 Broadway, 8 North, New York, NY 10032, USA
| | | | - Jeff Pawelek
- Growing Spine Foundation, 555 E Wells St, Milwaukee, WI 53202, USA
| | - Jeffrey R Sawyer
- Campbell Clinic Orthopaedics, 1211 Union Ave, Memphis, TN 38104, USA
| | - Behrooz A Akbarnia
- University of California, San Diego, 9500 Gilman Dr, La Jolla, CA 92093, USA
| | - David L Skaggs
- Children's Hospital of Los Angeles, 4650 Sunset Blvd, Los Angeles, CA 90027, USA
| | - Benjamin D Roye
- Columbia University Medical Center, 3959 Broadway, 8 North, New York, NY 10032, USA
| | - David P Roye
- Columbia University Medical Center, 3959 Broadway, 8 North, New York, NY 10032, USA
| | - Michael G Vitale
- Columbia University Medical Center, 3959 Broadway, 8 North, New York, NY 10032, USA
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Minkara AA, Lin AY, Vitale MG, Roye DP. Acute Kidney Injury Secondary to Cell Saver in Posterior Spinal Fusion. Spine Deform 2017; 5:430-434. [PMID: 29050721 DOI: 10.1016/j.jspd.2017.03.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 02/01/2017] [Accepted: 03/19/2017] [Indexed: 01/17/2023]
Abstract
BACKGROUND Autologous blood transfusion, commonly referred to as cell saver, is frequently used in spinal fusion to salvage red blood cells because of the risk of significant intraoperative blood loss. This case report describes a case of acute kidney injury (AKI) secondary to cell saver use. Our objective is to increase the knowledge about the process of red blood cell salvage and this exceedingly rare complication. METHODS Chart and renal biopsy results for a single case were reviewed and reported in this retrospective study. RESULTS A healthy 18-year-old male patient underwent posterior spinal instrumentation and fusion for adolescent idiopathic scoliosis with utilization of intraoperative autologous blood transfusion. The patient subsequently developed hematuria and AKI with a peak creatinine of 13.9 mg/dL. An extensive clinical workup, including autoimmune serology, excluded any identifying causes. A renal biopsy showed pigment-induced acute tubular necrosis. CONCLUSIONS This case, to our knowledge, is the first and only case report of AKI secondary to cell saver demonstrated by renal biopsy. The literature has shown both the benefit of cell saver by decreasing the need for allogeneic transfusion and the risk of transient hematuria. However, this case demonstrates the importance of monitoring patients for potential complications.
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Affiliation(s)
- Anas A Minkara
- Columbia University Medical Center, 3959 Broadway, 8 North, New York, NY 10032, USA
| | - Albert Y Lin
- Columbia University Medical Center, 3959 Broadway, 8 North, New York, NY 10032, USA
| | - Michael G Vitale
- Columbia University Medical Center, 3959 Broadway, 8 North, New York, NY 10032, USA
| | - David P Roye
- Columbia University Medical Center, 3959 Broadway, 8 North, New York, NY 10032, USA.
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Roye B, Hung CW, Matsumoto H, Campbell M, Roye DP, Vitale M. Paper #23: Comparison of Complications and unplanned OR visits between Magnetically Controlled Growing Rods and Vertical Expandable Prosthetic Titanium Rib. Spine Deform 2017; 5:451-452. [PMID: 31997187 DOI: 10.1016/j.jspd.2017.09.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Patients undergoing primary insertion of magnetically controlled growing rod (MCGR) compared to Vertical Expandable Prosthetic Titanium Rib (VEPTR) have higher overall complication and implant-related complications per procedure despite similar complication risk per patient. While there was a reduction in total repetitive surgeries in patients with MCGR implants, there was no significant difference in mean unplanned OR visits per patient between the groups.
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Matsumoto H, Campbell M, Minkara A, Roye DP, Garg S, Johnston C, Samdani A, Smith J, Sponseller P, Sturm PF, Vitale M. Paper #45: Development of a Risk Severity Score (RSS) Predicting Surgical Site Infection in Early Onset Scoliosis: Identifying High-Risk Patients. Spine Deform 2017; 5:464-465. [PMID: 31997165 DOI: 10.1016/j.jspd.2017.09.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The RSS was developed to quantify the risk of SSI when considering operative intervention in patients with early onset scoliosis undergoing spinal surgery. The tool includes neuromuscular etiology, myelomeningocele, spinal muscular atrophy, endocrine comorbidity, gastrointestinal comorbidity, pulmonary comorbidity, developmental delay, urinary incontinence, and ventriculoperitoneal shunt as predictive variables. The RSS can improve shared decision making with patients and families during preoperative counseling and aid policy makers and administrators in determining reliable and valid risk-adjusted outcome measures.
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Bagheri A, Liu XC, Tassone C, Thometz J, Chaloupka A, Tarima S, Cohen L, Simic M, Dennis S, Refshauge K, Pappas E, Parent EC, Pietrosanu M, Redford E, Schmidt S, Hill D, Moreau M, Hedden D, Adeeb S, Lou E, Brink RC, Schlösser TPC, Colo D, Vincken KL, van Stralen M, Hui SCN, Chu WCW, Cheng JCY, Castelein RM, Kechagias V, Grivas TB, Vlasis K, Michas K, Grivas TB, Kechagias V, Vlasis K, Michas K, Tam EMS, Yu FWP, Hung VWY, Shi L, Qin L, Ng BKW, Chu WCW, Griffith J, Cheng JCY, Lam TP, Xue C, Shi L, Hui SCN, Lam TP, Ng BKW, Cheng JCY, Chu WCW, Hui SCN, Pialasse JP, Wong JYH, Lam TP, Ng BKW, Cheng JCY, Chu WCW, Vo QN, Le LH, Lou EHM, Zheng R, Hill DL, Moreau MJ, Hedden DM, Mahood JK, Southon S, Lou E, Brignol A, Cheriet F, Miron MC, Laporte C, Qiu Y, Liu H, Liu Z, Zhu ZZ, Qian BP, Liu X, Rizza R, Thometz J, Rosol D, Tassone C, Tarima S, North P, Zaina F, Pesenti F, Negrini S, Persani L, Capodaglio P, Polli N, Yip BHK, Yu FWP, Hung VWY, Lam TP, Qin L, Ng BKW, Cheng JCY, Zhang J, Lee WYW, Chen H, Tam EMS, Man GC, Lam TP, Ng BKW, Qiu Y, Cheng JCY, Liu H, Liu Z, Zhu Z, Qian BP, Qiu Y, Harasymczuk P, Andrusiewicz M, Janusz P, Biecek P, Kotwicki T, Kotwicka M, Lee JS, Shin JK, Goh TS, Son SM, Chen H, Lee WYW, Zhang J, Tam EMS, Man GCW, Lam TP, Ng BKW, Qiu Y, Cheng JCY, Schwartz M, Gilday S, Bylski-Austrow DI, Glos DL, Schultz L, O’Hara S, Jain VV, Sturm PF, Wang X, Crandall DG, Parent S, Larson N, Labelle H, Aubin CE, Fard NB, Southon S, Moreau M, Hedden D, Duke K, Southon S, Lukenchuk L, Kerslake M, Huynh G, Chorney J, Tsui B, Tobert D, Bakarania P, Berdishevsky H, Grimes K, Matsumoto H, Hyman J, Roye B, Roye D, Vitale M, Black J, Bradley M, Drake S, Glynn D, Maude E, Berdishevsky H, Lindgren A, Bakarania P, Grimes K, Matsumoto H, Feinberg N, Bloom Z, Roye D, Vitale M, Dupuis S, Fortin C, Caouette C, Aubin CÉ, Gur G, Yakut Y, Jevtić N, Schreiber S, Hennes A, Pantović M, de Mauroy JC, Barral F, Pourret S, de Mauroy JC, Barral F, Pourret S, Aulisa AG, Guzzanti V, Galli M, Falciglia F, Aulisa L, Bernard JC, Deceuninck J, Berthonnaud E, Rougelot A, Pickering ME, Chaleat-Valayer E, Webb R, Bettany-Saltikov J, Neil B, Zaina F, Poggio M, Donzelli S, Lusini M, Minnella S, Negrini S, de Mauroy JC, Barral F, Hoang A, Mao S, Shi B, Qian B, Zhu Z, Sun X, Qiu Y, Cobetto N, Aubin CÉ, Parent S, Barch S, Turgeon I, Labelle H, Raihan HMA, Kumar DT, Khasnabis C, Equbal A, Chakraborty AK, Biswas A, Gur G, Dilek B, Ayhan C, Simsek E, Aras O, Aksoy S, Yakut Y, Lou E, Hill D, Zheng R, Donauer A, Tilburn M, Raso J, Morau M, Hedden D, Chen H, Man-Sang W, Cohen L, Kobayashi S, Simic M, Dennis S, Refshauge K, Pappas E, Aslanzadeh F, Parent EC, MacIntosh B, Maragkoudakis EG, Grivas TB, Gelalis ID, Mazioti C, Tsilimidos G, Burwell RG, Zheng Y, Wu XJ, Dang YN, Sun N, Yang Y, Wang T, He CQ, Wong MS, Donzelli S, Martinez G, Negrini A, Zaina F, Negrini S, Matsumoto H, Feinberg N, Shirley M, Swindell H, Bloom Z, Roye DP, Akbarnia BA, Garg S, Sanders JO, Skaggs DL, Smith JT, Vitale MG, Rizza R, Liu X, Thometz J, Lou E, Hill D, Donauer A, Tilburn M, Hedden D, Moreau M, Healy A, Farmer S, Chockalingam N, Aulisa AG, Guzzanti V, Galli M, Pizzetti P, Aulisa L, Maruyama T, Kobayashi Y, Nakao Y, Liu H, Qian BP, Qiu Y, Mao SH, Wang B, Yu Y, Zhu Z, Berdishevsky H, Lindgren AM, Bakarania P, Grimes K, Makhni MC, Shillingford J, Vitale MG, Black J, Maude E, Turland A, Glynn D, Caronni A, Sciumè L, Donzelli S, Zaina F, Negrini S, Schreiber S, Parent EC, Moez EK, Hedden DM, Hill DL, Moreau M, Lou E, Watkins EM, Southon SC, Parent EC, Schreiber S, Moez EK, Sloan P, Hedden D, Moreau M, Hill D, Southon S, Watkins E, Parent EC, Ghaneei M, Adeeb S, Schreiber S, Moreau M, Hedden D, Hill D, Southon S, Karavidas N, Dritsa D, Bettany-Saltikov J, Hanchard N, Kim D, Kim J, Sbihli A, Parent E, Levey L, Holowka M, Davis L, Dolan LA, Weinstein SL, Larson JE, Meyer MA, Boody B, Sarwark JF, Schreiber S, Parent EC, Hedden DM, Hill DL, Thometz J, Liu X, Rizza R, Tassone C, Liu X, Gundlach B, Tarima S, Grant A, Kalyan R, Hekal W, Honeyman C, Cook T, Murray S, Pitruzzella M, Donzelli S, Zaina F, Negrini S, de Mauroy JC, Barral F, Pourret S, de Mauroy JC, Barral F, Pourret S, Grimes K, Feinberg N, Hope J, Berdishevsky H, Bakarania P, Matsumoto H, Swindell H, Yoshimachi J, Roye D, Vitale M, Touchette J, St-Jean A, Brousseau D, Marcotte L, Théroux J, Doucet C, Lin Y, Wong MS, MacMahon J, MacMahon E, Boyette J, Stikeleather L, Lebel A, Lebel VA, Pancholi-Parekh CA, Stolze L, Selthafner M, Hong K, Liu X, Thometz J, Tassone C, Morrison PR, Hanke TA, Knott P, Krumdick ND, Chockalingam N, Shannon T, Davenhill R, Needham R, Jasani V, Ahmed EN, St-Jean A, Touchette J, Drake S, Brousseau D, Marcotte L, Théroux J, Doucet C, Aulisa AG, Guzzanti V, Gordano M, Mastantuoni G, Aulisa L, Chandrinos M, Grivas TB, Kechagias V, Głowka P, Gaweł D, Kasprzak B, Nowak M, Morzyński M, Kotwicki T, Deceuninck J, Bernard JC, Lecante C, Berthonnaud E, Fortin C, Aubin-Fournier JF, Bettany-Saltikov J, Parent EC, Feldman DE, Bernard JC, Liu Z, Zhang W, Hu Z, Zhu W, Jin M, Han X, Qiu Y, Cheng JCY, Zhu Z, Liu Z, Guo J, Wu T, Qian B, Zhu Z, Zhu F, Jiang J, Qiu Y, Han X, Liu Z, Liu H, Qiu Y, Guo J, Yan H, Sun X, Cheng JCY, Zhu Z, Di Felice F, Zaina F, Pitruzzella M, Donzelli S, Negrini S, Needham RA, Chatzistergos P, Chockalingam N, Brink RC, Schlösser TPC, Colo D, Vincken KL, van Stralen M, Hui SCN, Chu WCW, Cheng JCY, Castelein RM, Bylski-Austrow DI, Glos DL, Jain VV, Reynolds JE, Sturm PF, Wall EJ, Igoumenou VG, Megaloikonomos PD, Tsiavos K, Panagopoulos GN, Mavrogenis AF, Grivas TB, Soultanis K, Papagelopoulos PJ, Fard NB, Duke K, Chan A, Parent EC, Lou E, Lee JS, Shin JK, Goh TS, Son SM, Kobayashi S, Togawa D, Hasegawa T, Yamato Y, Oe S, Banno T, Mihara Y, Matsuyama Y. 13th International Conference on Conservative Management of Spinal Deformities and First Joint Meeting of the International Research Society on Spinal Deformities and the Society on Scoliosis Orthopaedic and Rehabilitation Treatment – SOSORT-IRSSD 2016 meeting. Scoliosis 2017. [PMCID: PMC5461518 DOI: 10.1186/s13013-017-0124-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Chan CM, Swindell HW, Matsumoto H, Park HY, Hyman JE, Vitale MG, Roye DP, Roye BD. Effect of Preoperative Indications Conference on Procedural Planning for Treatment of Scoliosis. Spine Deform 2016; 4:27-32. [PMID: 27852496 PMCID: PMC5561733 DOI: 10.1016/j.jspd.2015.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 04/01/2015] [Accepted: 05/22/2015] [Indexed: 11/17/2022]
Abstract
STUDY DESIGN This study determines the rate of change in the scoliosis surgery plan in cases presented in preoperative indications conference. OBJECTIVES To determine the effect of preoperative indications conference on the plan of surgery and to identify characteristics that increased the likelihood of change. SUMMARY OF BACKGROUND DATA Preoperative indications conferences are used as a teaching and planning tool. Levels of fusion, construct options, and necessity for osteotomies are often debated in the planning of scoliosis surgery. METHODS Scoliosis surgeries were presented at preoperative indications conference with four attending pediatric orthopedic surgeons present. The operative surgeon committed to a surgical plan before conference. A consensus-based plan was made without knowledge of the operative surgeon's preconference plan. Changes of plan were classified as major, minor, or no change. RESULTS Of the 107 surgical plans, 50 were index surgeries, 13 were revisions, and 44 were scheduled growing rod lengthenings. There were two major changes, including a change to a growing construct from planned fusion, and a change in fusion levels in an adolescent idiopathic scoliosis (AIS) patient. There were 13 minor changes, which included changes in fusion levels (1 to 3; mean = 1.23) and the addition of an osteotomy. The rate of change was 28% for index surgeries and 7.69% for revisions. Of the 14 changes in the 50 index surgeries, there were 8 AIS, 3 cerebral palsy, 1 congenital scoliosis, 1 Ehlers-Danlos, and 1 patient with an undetermined neuromuscular condition. There was 1 change in 13 revision surgeries. There were no changes for growing rod lengthenings and no cancellations as a result of indications conference. CONCLUSIONS Although revision scoliosis surgery is complex, index AIS/JIS surgery was most subject to the influence of indications conference. This likely reflects controversy around choosing levels of fusion. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Charles M. Chan
- Department of Orthopaedic Surgery, Stanford University, 450 Serra Mall, Stanford, CA 94305, USA
| | - Hasani W. Swindell
- Department of Orthopaedic Surgery, Columbia University, 116th St & Broadway, New York, NY 10027, USA
| | - Hiroko Matsumoto
- Department of Orthopaedic Surgery, Columbia University, 116th St & Broadway, New York, NY 10027, USA.
| | - Howard Y. Park
- Department of Orthopaedic Surgery, Columbia University, 116th St & Broadway, New York, NY 10027, USA
| | - Joshua E. Hyman
- Department of Orthopaedic Surgery, Columbia University, 116th St & Broadway, New York, NY 10027, USA
| | - Michael G. Vitale
- Department of Orthopaedic Surgery, Columbia University, 116th St & Broadway, New York, NY 10027, USA
| | - David P. Roye
- Department of Orthopaedic Surgery, Columbia University, 116th St & Broadway, New York, NY 10027, USA
| | - Benjamin D. Roye
- Department of Orthopaedic Surgery, Columbia University, 116th St & Broadway, New York, NY 10027, USA
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Roye BD, Wright ML, Matsumoto H, Yorgova P, McCalla D, Hyman JE, Roye DP, Shah SA, Vitale MG. An Independent Evaluation of the Validity of a DNA-Based Prognostic Test for Adolescent Idiopathic Scoliosis. J Bone Joint Surg Am 2015; 97:1994-8. [PMID: 26677232 DOI: 10.2106/jbjs.o.00217] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND ScoliScore is a DNA-based prognostic test, designed and used to help to predict the risk of curve progression in patients with adolescent idiopathic scoliosis. The role of this test in clinical practice remains unclear as the published results of the ScoliScore have not been validated independently. The purpose of this study was to determine if the ScoliScore effectively predicted the risk of curve progression in patients with mild and moderate adolescent idiopathic scoliosis in two urban academic medical centers. METHODS One hundred and twenty-six patients with adolescent idiopathic scoliosis who met inclusion criteria at two centers were administered the ScoliScore test. Two groups were created: a progression group (those who had a Cobb angle of >40° or those who had undergone surgical fusion) and a non-progression group (those who had skeletal maturity without curve progression to 40°). ScoliScore values and risk levels were compared between the two groups. The negative predictive value was calculated for low-risk scores and the positive predictive value was calculated for high-risk scores. RESULTS There was no significant difference (p = 0.706) in the mean ScoliScore (and standard deviation) between patients with curve progression (107 ± 55 points) and those without curve progression (102 ± 62 points). There was also no significant difference (p = 0.399) in curve progression between patients with high-risk scores (26.7%) and those with low-risk scores (12.9%). The positive predictive value of the test was 0.27 (95% confidence interval, 0.09 to 0.55), and the negative predictive value was 0.87 (95% confidence interval, 0.69 to 0.96). ScoliScores and rates of progression were not affected by brace-wear. CONCLUSIONS ScoliScores did not differ between patients with and without curve progression, and the negative and positive predictive values were lower in our study than in the previously published validation study by the developers of the test. This may be due to differences in our test population, genetic variability, or failure of patients in the non-progression group to follow up.
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Affiliation(s)
- Benjamin D Roye
- Columbia University Medical Center/New York Presbyterian Hospital, CHONY-8N, 3959 Broadway, New York, NY 10032-3784. E-mail address for H. Matsumoto:
| | - Margaret L Wright
- Columbia University Medical Center/New York Presbyterian Hospital, CHONY-8N, 3959 Broadway, New York, NY 10032-3784. E-mail address for H. Matsumoto:
| | - Hiroko Matsumoto
- Columbia University Medical Center/New York Presbyterian Hospital, CHONY-8N, 3959 Broadway, New York, NY 10032-3784. E-mail address for H. Matsumoto:
| | - Petya Yorgova
- Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19803
| | - Daren McCalla
- Columbia University Medical Center/New York Presbyterian Hospital, CHONY-8N, 3959 Broadway, New York, NY 10032-3784. E-mail address for H. Matsumoto:
| | - Joshua E Hyman
- Columbia University Medical Center/New York Presbyterian Hospital, CHONY-8N, 3959 Broadway, New York, NY 10032-3784. E-mail address for H. Matsumoto:
| | - David P Roye
- Columbia University Medical Center/New York Presbyterian Hospital, CHONY-8N, 3959 Broadway, New York, NY 10032-3784. E-mail address for H. Matsumoto:
| | - Suken A Shah
- Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19803
| | - Michael G Vitale
- Columbia University Medical Center/New York Presbyterian Hospital, CHONY-8N, 3959 Broadway, New York, NY 10032-3784. E-mail address for H. Matsumoto:
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Tauchi R, Tsuji T, Cahill PJ, Flynn JM, Flynn JM, Glotzbecker M, El-Hawary R, Heflin JA, Imagama S, Joshi AP, Nohara A, Ramirez N, Roye DP, Saito T, Sawyer JR, Smith JT, Kawakami N. Reliability analysis of Cobb angle measurements of congenital scoliosis using X-ray and 3D-CT images. Eur J Orthop Surg Traumatol 2015; 26:53-7. [PMID: 26377663 DOI: 10.1007/s00590-015-1701-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 09/07/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Therapeutic decisions for congenital scoliosis rely on Cobb angle measurements on consecutive radiographs. There have been no studies documenting the variability of measuring the Cobb angle using 3D-CT images in children with congenital scoliosis. The purpose of this study was to compare the reliability and measurement errors using X-ray images and those utilizing 3D-CT images. MATERIALS AND METHODS The X-ray and 3D-CT images of 20 patients diagnosed with congenital scoliosis were used to assess the reliability of the digital 3D-CT images for the measurement of the Cobb angle. Thirteen observers performed the measurements, and each image was analyzed by each observer twice with a minimum interval of 1 week between measurements. The analysis of intraobserver variation was expressed as the mean absolute difference (MAD) and standard deviation (SD) between measurements and the intraclass correlation coefficient (IaCC) of the measurements. In addition, the interobserver variation was expressed as the MAD and interclass correlation coefficient (IeCC). RESULTS The average MAD and SD was 4.5° and 3.2° by the X-ray method and 3.7° and 2.6° by the 3D-CT method. The intraobserver and interobserver intraclass ICCs were excellent in both methods (X-ray: IaCC 0.835-0.994 IeCC 0.847, 3D-CT: IaCC 0.819-0.996 IeCC 0.893). There was no significant MAD difference between X-ray and 3D-CT images in measuring each type of congenital scoliosis by each observer. CONCLUSIONS Results of Cobb angle measurements in patients with congenital scoliosis using X-ray images in the frontal plane could be reproduced with almost the same measurement variance (3°-4° measurement error) using 3D-CT images. This suggests that X-ray images are clinically useful for assessing any type of congenital scoliosis about measuring the Cobb angle alone. However, since 3D-CT can provide more detailed images of the anterior and posterior components of malformed vertebrae, the volume of information that can be obtained by evaluating them has contributed greatly to the development of strategies for the surgical treatment of congenital scoliosis.
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Affiliation(s)
- Ryoji Tauchi
- Department of Orthopedics and Spine Surgery, Meijo Hospital, 1-3-1, Sannomaru, Naka-ku, Nagoya, 460-0001, Japan
| | - Taichi Tsuji
- Department of Orthopedics and Spine Surgery, Meijo Hospital, 1-3-1, Sannomaru, Naka-ku, Nagoya, 460-0001, Japan
| | - Patrick J Cahill
- Department of Orthopedic Surgery, Shriners Hospitals for Children-Philadelphia, Philadelphia, PA, USA
| | - John M Flynn
- Division of Orthopaedics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - John M Flynn
- Department of Pediatric Orthopaedic Surgery, Hospital la Conception, San German, PR, USA
| | - Michael Glotzbecker
- Department of Orthopaedic Surgery, Children's Hospital Boston, Boston, MA, USA
| | - Ron El-Hawary
- Division of Pediatric Orthopaedics, Isaac Walton Killam Health Centre, Halifax, NS, Canada
| | - John A Heflin
- Department of Orthopaedic Surgery, Emory University School of Medicine, Emory Spine Center, Atlanta, GA, USA
| | - Shiro Imagama
- Department of Orthopaedic Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | - Ayato Nohara
- Department of Orthopedics and Spine Surgery, Meijo Hospital, 1-3-1, Sannomaru, Naka-ku, Nagoya, 460-0001, Japan
| | - Norman Ramirez
- Department of Pediatric Orthopaedic Surgery, Hospital la Conception, San German, PR, USA
| | - David P Roye
- Department of Pediatric Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
| | - Toshiki Saito
- Department of Orthopedics and Spine Surgery, Meijo Hospital, 1-3-1, Sannomaru, Naka-ku, Nagoya, 460-0001, Japan
| | | | - John T Smith
- Department of Orthopaedics, University of Utah, Salt Lake City, UT, USA
| | - Noriaki Kawakami
- Department of Orthopedics and Spine Surgery, Meijo Hospital, 1-3-1, Sannomaru, Naka-ku, Nagoya, 460-0001, Japan.
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Matsumoto H, Colacchio ND, Schwab FJ, Lafage V, Roye DP, Vitale MG. Flatback Revisited: Reciprocal Loss of Lumbar Lordosis Following Selective Thoracic Fusion in the Setting of Adolescent Idiopathic Scoliosis. Spine Deform 2015; 3:345-351. [PMID: 27927480 DOI: 10.1016/j.jspd.2015.01.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 12/12/2014] [Accepted: 01/23/2015] [Indexed: 10/23/2022]
Abstract
STUDY DESIGN Retrospective review of prospective multicenter adolescent idiopathic scoliosis (AIS) database. OBJECTIVE To investigate the relationship between iatrogenic loss of thoracic kyphosis (TK) after selective thoracic posterior spinal instrumentation and fusion (PSIF) for AIS with straightening of lumbar lordosis (LL). SUMMARY OF BACKGROUND DATA Segmental PSIF has become the standard of care for surgical treatment of severe AIS. Studies show that adults with flattening of TK and LL can develop pain and dysfunction associated with flatback syndrome. Analysis of post-fusion sagittal alignment is lacking in the AIS population. METHODS Query of prospective multicenter database for AIS patients with Lenke 1, 2, or 3 curves who underwent selective thoracic PSIF (lowest instrumented vertebra equal or cephalad to L1) identified 123 patients with a minimum of 2 years' follow-up. Thoracic kyphosis (T5-T12), LL (T12-S1), and global sagittal alignment were measured preoperatively and at 2 years postoperatively. Health-related quality of life measures were examined. RESULTS A total of 31% of patients had loss of TK and 42% lost LL. Patients with decreased TK had significantly higher rates of decreased LL (68%) than patients without decreased TK (31%). Multivariate regression confirmed that TK had significant predictive effect on LL (p < .001). Specifically, change in TK of 2° was associated with roughly 3° change in LL. There were no significant associations between changes in TK or LL and health-related quality of life. CONCLUSIONS Loss of TK occurs commonly in selective fusion for AIS. This loss of kyphosis is strongly associated with reciprocal loss of LL. Spinal fusion can have unintended effects on sagittal alignment; these effects may have consequences that remain to be fully elucidated.
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Affiliation(s)
- Hiroko Matsumoto
- Department of Orthopaedic Surgery, Columbia University Medical Center, 3959 Broadway, 800 North, New York, NY 10032, USA; Department of Epidemiology, Mailmen School of Public Health at Columbia University, 722 West 168th Street, New York, NY 10032, USA.
| | | | - Frank J Schwab
- Department of Orthopaedic Surgery, New York University Medical School, 301 East 17th Street, New York, NY 10003, USA
| | - Virginie Lafage
- Department of Orthopaedic Surgery, New York University Medical School, 301 East 17th Street, New York, NY 10003, USA
| | - David P Roye
- Department of Orthopaedic Surgery, Columbia University Medical Center, 3959 Broadway, 800 North, New York, NY 10032, USA
| | - Michael G Vitale
- Department of Orthopaedic Surgery, Columbia University Medical Center, 3959 Broadway, 800 North, New York, NY 10032, USA
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Matsumoto H, Colacchio ND, Schwab FJ, Lafage V, Sheha ED, Roye DP, Vitale MG. Unintended Change of Physiological Lumbar Lordosis and Pelvic Tilt After Posterior Spinal Instrumentation and Fusion for Adolescent Idiopathic Scoliosis: How Much Is Too Much? Spine Deform 2015; 3:180-187. [PMID: 27927310 DOI: 10.1016/j.jspd.2014.08.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 07/17/2014] [Accepted: 08/31/2014] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN Retrospective review of prospective multicenter adolescent idiopathic scoliosis (AIS) database. OBJECTIVES To investigate the effect of decreased lumbar lordosis (LL) on measured pelvic tilt (PT) after posterior spinal instrumentation and fusion for AIS and to test the hypothesis that lumbar spinal fusion resulting in mismatched LL is associated with increased PT. SUMMARY OF BACKGROUND DATA Interaction between the spine and pelvis highly influences global sagittal alignment (GSA). In adults, correlation between health-related quality of life measures and LL proportional to a patient-specific pelvic incidence (PI) has been established, although the implications of poor sagittal alignment are less well-defined in AIS. This observation warrants further examination of regional spine contour and its relation to the pelvis in AIS. METHODS The authors queried a prospective multicenter database for AIS patients who underwent posterior spinal instrumentation and fusion with lowest instrumented vertebra between L2 and L5 and identified 155 patients with minimum 2 years' follow-up. Lumbar lordosis (T12-S1), LL within fusion, LL below fusion, GSA, PT, and PI were measured preoperatively and at 2 years. Change in PT was compared between patients with matched or mismatched LL based on a common clinical definition (LL = PI + 10) and a research-driven model (LL = 0.56 PI + 33.43). RESULTS Thirty-eight percent of patients had decreased LL from before surgery to 2 years after surgery. These patients had significantly higher rates of increased PT (73%) than patients without decreased LL (40%). Multivariate regression demonstrated that change in LL, LL within fusion, and GSA had a significant predictive effect on PT (p < .001). Using either definition of LL, patients with LL less than 2 standard deviations from predicted values were more likely to have increased PT. CONCLUSIONS Iatrogenic loss of LL commonly occurs in spine fusion for AIS and is associated with a reciprocal increase in PT. As such, spinal fusion in AIS can have unintended effects on sagittal alignment with currently uninvestigated potential consequences in the future.
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Affiliation(s)
- Hiroko Matsumoto
- Department of Orthopaedic Surgery, Columbia University Medical Center, 3959 Broadway Avenue, 8 North, New York, NY, USA.
| | - Nicholas D Colacchio
- Department of Orthopaedic Surgery, Columbia University Medical Center, 3959 Broadway Avenue, 8 North, New York, NY, USA
| | - Frank J Schwab
- Department of Orthopaedic Surgery, New York University Medical School, New York, NY, USA
| | - Virginie Lafage
- Department of Orthopaedic Surgery, New York University Medical School, New York, NY, USA
| | - Evan D Sheha
- Department of Orthopaedic Surgery, Columbia University Medical Center, 3959 Broadway Avenue, 8 North, New York, NY, USA
| | - David P Roye
- Department of Orthopaedic Surgery, Columbia University Medical Center, 3959 Broadway Avenue, 8 North, New York, NY, USA
| | - Michael G Vitale
- Department of Orthopaedic Surgery, Columbia University Medical Center, 3959 Broadway Avenue, 8 North, New York, NY, USA
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Williams BA, Matsumoto H, McCalla DJ, Akbarnia BA, Blakemore LC, Betz RR, Flynn JM, Johnston CE, McCarthy RE, Roye DP, Skaggs DL, Smith JT, Snyder BD, Sponseller PD, Sturm PF, Thompson GH, Yazici M, Vitale MG. Development and initial validation of the Classification of Early-Onset Scoliosis (C-EOS). J Bone Joint Surg Am 2014; 96:1359-67. [PMID: 25143496 DOI: 10.2106/jbjs.m.00253] [Citation(s) in RCA: 181] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Early-onset scoliosis is a heterogeneous condition, with highly variable manifestations and natural history. No standardized classification system exists to describe and group patients, to guide optimal care, or to prognosticate outcomes within this population. A classification system for early-onset scoliosis is thus a necessary prerequisite to the timely evolution of care of these patients. METHODS Fifteen experienced surgeons participated in a nominal group technique designed to achieve a consensus-based classification system for early-onset scoliosis. A comprehensive list of factors important in managing early-onset scoliosis was generated using a standardized literature review, semi-structured interviews, and open forum discussion. Three group meetings and two rounds of surveying guided the selection of classification components, subgroupings, and cut-points. Initial validation of the system was conducted using an interobserver reliability assessment based on the classification of a series of thirty cases. RESULTS Nominal group technique was used to identify three core variables (major curve angle, etiology, and kyphosis) with high group content validity scores. Age and curve progression ranked slightly lower. Participants evaluated the cases of thirty patients with early-onset scoliosis for reliability testing. The mean kappa value for etiology (0.64) was substantial, while the mean kappa values for major curve angle (0.95) and kyphosis (0.93) indicated almost perfect agreement. The final classification consisted of a continuous age prefix, etiology (congenital or structural, neuromuscular, syndromic, and idiopathic), major curve angle (1, 2, 3, or 4), and kyphosis (-, N, or +) variables, and an optional progression modifier (P0, P1, or P2). CONCLUSIONS Utilizing formal consensus-building methods in a large group of surgeons experienced in treating early-onset scoliosis, a novel classification system for early-onset scoliosis was developed with all core components demonstrating substantial to excellent interobserver reliability. This classification system will serve as a foundation to guide ongoing research efforts and standardize communication in the clinical setting.
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Affiliation(s)
- Brendan A Williams
- Department of Orthopaedic Surgery (B.A.W., D.J.M., D.P.R., and M.G.V.), and Division of Pediatric Orthopaedic Surgery (H.M.), Columbia University Medical Center, 3959 Broadway, 8 North, New York, NY 10032. E-mail address for M.G. Vitale:
| | - Hiroko Matsumoto
- Department of Orthopaedic Surgery (B.A.W., D.J.M., D.P.R., and M.G.V.), and Division of Pediatric Orthopaedic Surgery (H.M.), Columbia University Medical Center, 3959 Broadway, 8 North, New York, NY 10032. E-mail address for M.G. Vitale:
| | - Daren J McCalla
- Department of Orthopaedic Surgery (B.A.W., D.J.M., D.P.R., and M.G.V.), and Division of Pediatric Orthopaedic Surgery (H.M.), Columbia University Medical Center, 3959 Broadway, 8 North, New York, NY 10032. E-mail address for M.G. Vitale:
| | - Behrooz A Akbarnia
- San Diego Center for Spinal Disorders, 4130 La Jolla Village Drive, Suite 300, San Diego, La Jolla, CA 92037
| | - Laurel C Blakemore
- Department of Orthopaedic Surgery and Sports Medicine, Children's National Medical Center, 111 Michigan Avenue, N.W., Washington, DC 20010
| | - Randal R Betz
- Department of Orthopaedic Surgery, Shriner's Hospital for Children, 3551 North Broad Street, Philadelphia, PA 19140
| | - John M Flynn
- Division of Orthopaedics, Children's Hospital of Philadelphia, 324 South 34th Street, Philadelphia, PA 19104
| | - Charles E Johnston
- Department of Orthopedic Surgery, Texas Scottish Rite Hospital for Children, 2222 Welborn Street, Dallas, TX 75219
| | - Richard E McCarthy
- Departments of Orthopaedics and Pediatrics, University of Arkansas for Medical Sciences, 1 Children's Way, Little Rock, AR 72202
| | - David P Roye
- Department of Orthopaedic Surgery (B.A.W., D.J.M., D.P.R., and M.G.V.), and Division of Pediatric Orthopaedic Surgery (H.M.), Columbia University Medical Center, 3959 Broadway, 8 North, New York, NY 10032. E-mail address for M.G. Vitale:
| | - David L Skaggs
- Children's Orthopaedic Center, Children's Hospital Los Angeles, 4650 Sunset Boulevard, Mailstop #69, Los Angeles, CA 90027
| | - John T Smith
- Department of Orthopaedics and Pediatrics, The University of Utah School of Medicine, Primary Children's Medical Center, 100 Mario Capecchi Drive, Salt Lake City, UT 84113
| | - Brian D Snyder
- Department of Orthopaedic Surgery, Children's Hospital, Harvard Medical School, 300 Longwood Avenue, Boston, MA 02115
| | - Paul D Sponseller
- Department of Orthopaedic Surgery, The Johns Hopkins University, 1800 Orleans Street, 7359A, Baltimore, MD 21287
| | - Peter F Sturm
- Division of Orthopaedic Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45267
| | - George H Thompson
- Division of Pediatric Orthopaedic Surgery, Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106
| | - Muharrem Yazici
- Department of Orthopaedics and Traumatology, Hacettepe University, 06100 Sihhiye, Ankara, Turkey
| | - Michael G Vitale
- Department of Orthopaedic Surgery (B.A.W., D.J.M., D.P.R., and M.G.V.), and Division of Pediatric Orthopaedic Surgery (H.M.), Columbia University Medical Center, 3959 Broadway, 8 North, New York, NY 10032. E-mail address for M.G. Vitale:
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Gigante P, McDowell MM, Bruce SS, Chirelstein G, Chiriboga CA, Dutkowsky J, Fontana E, Hyman J, Kim H, Morgan D, Pearson TS, Roye BD, Roye DP, Ryan P, Vitale M, Anderson RCE. Reduction in upper-extremity tone after lumbar selective dorsal rhizotomy in children with spastic cerebral palsy. J Neurosurg Pediatr 2013; 12:588-94. [PMID: 24116982 DOI: 10.3171/2013.9.peds12591] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Randomized clinical trials have established that lumbar selective dorsal rhizotomy (SDR) reduces lower-extremity tone and improves functional outcome in children with spastic cerebral palsy. Significant data exist to support a secondary effect on upper-extremity function in patients with upper-extremity spasticity. The effects of SDR on upper-extremity tone, however, are not well characterized. In this report, the authors sought to assess changes in upper-extremity tone in individual muscle groups after SDR and tried to determine if these changes could be predicted preoperatively. METHODS The authors retrospectively reviewed 42 children who underwent SDR at Columbia University Medical Center/Morgan Stanley Children's Hospital of NewYork-Presbyterian between 2005 and 2011. Twenty-five had upper-extremity spasticity. All underwent pre- and postoperative examination for measuring tone (Modified Ashworth Scale) and assessing functional outcome. Follow-up examinations with therapists were performed at least once at a minimum of 2 months postoperatively (mean 15 months). RESULTS In the upper extremities, 23 (92%) of 25 patients had improvements of at least 1 Ashworth point in 2 or more independent motor groups on the Modified Ashworth Scale, and 12 (71%) of 17 families surveyed reported increases in motor control or spontaneous movement. The mean Modified Ashworth Scale scores for all upper-extremity muscle groups demonstrated an improvement from 1.34 to 1.22 (p < 0.001). Patients with a mean preoperative upper-extremity tone of 1.25-1.75 were most likely to benefit from reduction in tone (p = 0.0019). Proximal and pronator muscle groups were most likely to demonstrate reduced tone. CONCLUSIONS In addition to improvements in lower-extremity tone and function, SDR has demonstrable effects on upper extremities. Greater than 90% of our patients with elevated upper-extremity tone demonstrated reduction in tone in at least 2 muscle groups postoperatively. Patients with a mean Modified Ashworth Scale upper-extremity score of 1.25-1.75 may encounter the greatest reduction in upper-extremity tone.
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Affiliation(s)
- Paul Gigante
- Department of Neurological Surgery, Columbia University; and
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Corona J, Miller DJ, Downs J, Akbarnia BA, Betz RR, Blakemore LC, Campbell RM, Flynn JM, Johnston CE, McCarthy RE, Roye DP, Skaggs DL, Smith JT, Snyder BD, Sponseller PD, Sturm PF, Thompson GH, Yazici M, Vitale MG. Evaluating the extent of clinical uncertainty among treatment options for patients with early-onset scoliosis. J Bone Joint Surg Am 2013; 95:e67. [PMID: 23677368 DOI: 10.2106/jbjs.k.00805] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Literature guiding the management of early-onset scoliosis consists primarily of studies with a low level of evidence. Evaluation of clinical equipoise (i.e., when there is no known superiority among treatment modalities) allows for prioritization of research efforts. The objective of this study was to evaluate areas of clinical uncertainty among pediatric spine surgeons regarding the treatment of early-onset scoliosis. METHODS Fourteen experienced pediatric spine surgeons participated in semistructured interviews to identify clinical variables that influence decision making in the treatment of early-onset scoliosis. A series of case scenarios of 315 patients with idiopathic and neuromuscular early-onset scoliosis was then developed to be representative of those encountered in clinical practice. Using an online survey, eleven surgeons selected their choice of eight treatment options for each case scenario. Associations between case characteristics and treatment choices were assessed with chi-square and logistic regression analysis. Participants then reviewed the areas of treatment uncertainty identified in the survey, nominated additional research questions of interest, and ranked their interest to further explore the identified research questions. RESULTS Collective equipoise was identified in numerous scenarios in the survey spanning a range of ages and magnitudes of scoliosis, and additional questions were identified during the nominal group technique. Areas that had the greatest clinical uncertainty included the management of patients who have finished treatment with a growing-rod, timing of rod-lengthening intervals, and indications for spine-based and rib-based proximal instrumentation anchors. The use of rib anchors compared with spine-based anchors was ranked highly for consideration in future clinical trials. CONCLUSIONS Variability in decision making with regard to the optimum treatment of certain subsets of patients with early-onset scoliosis reflects gaps in the available evidence. Structured consensus methods identified priorities for higher levels of research in this area of scoliosis. Higher-level studies, including randomized trials, should focus on answering the questions highlighted in this report.
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Affiliation(s)
- Jacqueline Corona
- Division of Orthopaedic Surgery, Southern Illinois University School of Medicine, 701 North First Street, Room D220, Springfield, IL 62702, USA
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Mackenzie WGS, Matsumoto H, Williams BA, Corona J, Lee C, Cody SR, Covington L, Saiman L, Flynn JM, Skaggs DL, Roye DP, Vitale MG. Surgical site infection following spinal instrumentation for scoliosis: a multicenter analysis of rates, risk factors, and pathogens. J Bone Joint Surg Am 2013; 95:800-6, S1-2. [PMID: 23636186 DOI: 10.2106/jbjs.l.00010] [Citation(s) in RCA: 123] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Surgical site infection following correction of pediatric scoliosis is well described. However, we are aware of no recent multicenter study describing the rates of surgical site infection, and associated pathogens, among patients with different etiologies for scoliosis. METHODS A multicenter, retrospective review of surgical site infections among pediatric patients undergoing spinal instrumentation to correct scoliosis was performed at three children's hospitals in the United States. Study subjects included all patients undergoing posterior spinal instrumentation from January 2006 to December 2008. Surgical site infections were defined according to the Centers for Disease Control and Prevention's National Healthcare Safety Network case definition, with infections occurring within one year after surgery. RESULTS Following the analysis of 1347 procedures performed in 946 patients, surgical site infection rates varied among procedures performed in patients with different scoliosis etiologies. Procedures performed in patients with neuromuscular scoliosis had the highest surgical site infection rates (9.2%), followed by those performed in patients with syndromic scoliosis (8.8%), those performed in patients with other scoliosis (8.4%), those performed in patients with congenital scoliosis (3.9%), and those performed in patients with idiopathic scoliosis (2.6%). Surgical site infection rates varied among procedures in patients undergoing primary spinal arthrodesis based on etiology, ranging from 1.2% (95% confidence interval, 0.1% to 1.3%) in patients with idiopathic scoliosis to 13.1% (95% confidence interval, 8.4% to 17.8%) in patients with neuromuscular scoliosis. Surgical site infection rates following primary and revision procedures were similar among patients with different etiologies. In distraction-based growing constructs, rates were significantly lower for lengthening procedures than for revision procedures (p = 0.012). Multivariate analysis demonstrated that non-idiopathic scoliosis and extension of instrumentation to the pelvis were risk factors for surgical site infections. The three most common pathogens were Staphylococcus aureus (25.0% [95% confidence interval, 17.8% to 32.2%]), coagulase-negative staphylococci (17.1% [95% confidence interval, 10.9% to 23.3%]), and Pseudomonas aeruginosa (10.7% [95% confidence interval, 5.6% to 15.8%]). Overall, 46.5% (95% confidence interval, 35.5% to 57.5%) of surgical site infections contained at least one gram-negative organism; 97.0% (95% confidence interval, 90.8% to 100.0%) of these infections were in patients with non-idiopathic scoliosis. CONCLUSIONS Surgical site infection rates were significantly higher following procedures in patients with non-idiopathic scoliosis (p < 0.001). Lengthening procedures had the lowest rate of surgical site infection among patients with early onset scoliosis who had undergone instrumentation with growing constructs. Gram-negative pathogens were common and were most common following procedures in patients with non-idiopathic scoliosis. These findings suggest a role for targeted perioperative antibiotic prophylaxis to prevent surgical site infection following pediatric scoliosis instrumentation procedures.
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Affiliation(s)
- W G Stuart Mackenzie
- Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University Medical Center, 3959 Broadway, Suite 8 North, New York, NY 10032, USA
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Privitera DM, Matsumoto H, Gomez JA, Roye DP, Hyman JE, Vitale MG. Are Breech Rates for Pedicle Screws Higher in the Upper Thoracic Spine? Spine Deform 2013; 1:189-195. [PMID: 27927292 DOI: 10.1016/j.jspd.2013.04.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 03/07/2013] [Accepted: 04/07/2013] [Indexed: 11/15/2022]
Abstract
STUDY DESIGN A case-control study. OBJECTIVES To evaluate pedicle screw placement in pediatric patients with various etiologies of scoliosis, and to identify predictors of misplacement. SUMMARY OF BACKGROUND DATA Accuracy of placement of pedicle screws has not been well documented for posterior spinal instrumentation and fusion performed in the non-idiopathic population. METHODS A total of 54 patients (29 idiopathic, 16 neuromuscular, and 9 congenital/syndromic scoliosis), ages 5-19 years, were included. Computed tomography scans were obtained on patients postoperatively to assess screw position. Three pediatric orthopedic surgeons evaluated screw placement, and risk factors for misplacement were examined. RESULTS Of 1,042 pedicle screws, 8.3% were misplaced. Among all etiologies, screws placed at T1 (28.6%) and T2 (18.2%) had higher misplacement rates. T2 screws and curve correction greater than 75% had higher misplacement rates in congenital/syndromic patients; screws at T3, screws at upper end of construct, and proximal screws had significantly higher misplacement rates in neuromuscular patients; and no variables predicted misplacement in idiopathics. Screws placed at the most proximal end of the screw/rod construct also had a higher misplacement rate (14.1%) compared with all remaining levels (7.8%). Nonidiopathic patients had higher anterior misplacement compared with idiopathic. No screws were removed or revised, and no screw-related complications were observed. CONCLUSIONS Pedicle screw instrumentation in the thoracolumbar spine was safe for pediatric patients. We found that pedicle screws placed at top levels are at higher risk for misplacement among all pediatric scoliosis patients. Nonidiopathic patients are at higher risk for anterior screw misplacement, and the predictive effect of vertebral level is more profound in nonidiopathic patients. Because of these findings, we routinely use fluoroscopic guidance for the placement of T1 and T2 screws, and screws at the proximal end of construct.
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Affiliation(s)
- David M Privitera
- Department of Orthopaedic Surgery, State University of New York at Buffalo, 3435 Main Street, Buffalo, NY 14214, USA
| | - Hiroko Matsumoto
- Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University, 3959 Broadway 800 North, New York, NY 10032, USA.
| | - Jaime A Gomez
- Department of Orthopaedic Surgery, Columbia University, 622 West 168 Street, PH11-Center, New York, NY 10032, USA
| | - David P Roye
- Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University, 3959 Broadway 800 North, New York, NY 10032, USA; Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, 3959 Broadway 800 North, New York, NY 10032, USA
| | - Joshua E Hyman
- Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University, 3959 Broadway 800 North, New York, NY 10032, USA; Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, 3959 Broadway 800 North, New York, NY 10032, USA
| | - Michael G Vitale
- Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University, 3959 Broadway 800 North, New York, NY 10032, USA; Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, 3959 Broadway 800 North, New York, NY 10032, USA
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Abstract
BACKGROUND In contrast with treatment recommendations for adolescent idiopathic scoliosis, there are no clear algorithms for treating patients with early-onset scoliosis. There has been rapid expansion of treatment options for children with early-onset scoliosis, including casting, growth rods, the vertical expandable prosthetic titanium rib, and anterior vertebral stapling. QUESTIONS/PURPOSES Given the range of treatment options, we assessed variability in decision making regarding treatment of patients with early-onset scoliosis. METHODS We presented 12 clinical and radiographic vignettes about patients with early-onset scoliosis to 13 experienced spine surgeons who are members of the Chest Wall and Spine Deformity Study Group. The reviewers were asked to choose type of treatment, type of construct, construct location, and whether a thoracotomy should be performed. RESULTS All 13 surgeons agreed regarding the need for surgery in eight of the 12 cases. When the reviewers chose surgery, 76% (40%-100%) selected the vertical expandable prosthetic titanium rib; of those selecting that approach, 61% (0%-100%) coincided on using it bilaterally. Agreement was 20% (0%-60%) for growing rods and 4% (0%-25%) for fusions. Among all cases, agreement regarding whether instrumentation should extend to the pelvis was 71% (50%-100%). In all but two cases, at least 85% of surgeons recommended against a thoracotomy. CONCLUSIONS Although most surgeons agreed about the indication for surgery, we found wide variability in choice of construct type, number of constructs, and level of instrumentation.
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Affiliation(s)
- Michael G. Vitale
- Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University, Morgan Stanley Children’s Hospital of New York-Presbyterian, Columbia University Medical Center, 3959 Broadway 800 North, New York, NY 10032 USA
| | - Jaime A. Gomez
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY USA
| | - Hiroko Matsumoto
- Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University, Morgan Stanley Children’s Hospital of New York-Presbyterian, Columbia University Medical Center, 3959 Broadway 800 North, New York, NY 10032 USA
| | - David P. Roye
- Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University, Morgan Stanley Children’s Hospital of New York-Presbyterian, Columbia University Medical Center, 3959 Broadway 800 North, New York, NY 10032 USA
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Vitale MG, Corona J, Matsumoto H, Avendano J, Pinder D, Miller DJ, Roye DP. Development and initial validation of a disease specific outcome measure for early onset scoliosis. Stud Health Technol Inform 2010; 158:172-176. [PMID: 20543419] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
INTRODUCTION Treatment of children with early onset scoliosis (EOS) seeks to improve natural history and health related quality of life (QOL). QOL measurement presents a significant challenge given the young age, comorbidities, and heterogeneity of this population. OBJECTIVE To develop a disease specific measure reflecting issues of importance to EOS patients and caretakers. MATERIALS AND METHODS Review of the literature and relevant measures informed development of semi-structured qualitative interviews. Interviews of caregivers of EOS patients were interpreted through the framework technique. A master-list of 75-items was created and responses were scaled on a 5-point Likert-scale. Psychometric analysis was performed to group items into domains, to maintain score distribution, to create a responsive instrument, and to identify question redundancy. RESULTS Content validation revealed 8-items with low content validity indices. Item distribution analysis demonstrated 19-items with skewed distribution. Item reliability demonstrated redundant items within domains (r> or =0.5). Construct validity demonstrated unique domains measuring intended issues of interest. The resulting Early Onset Scoliosis Questionnaire (EOSQ) includes 33-items in 13-domains: General Health, Pain, Physical Function, Pulmonary Function, Daily Living, Fatigue, Emotion, Surgical Concerns, Satisfaction, Transfer, Financial Burden, Parental Burden, and Treatment Outcomes. CONCLUSION The EOSQ reflects QOL and caregiver burden in the EOS population. The EOSQ will expand options for outcome assessment in this unique population.
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Affiliation(s)
- Michael G Vitale
- Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia University, College of Physicians and Surgeons, New York, NY, USA
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Miller DJ, Jameel O, Matsumoto H, Hyman JE, Schwab FJ, Roye DP, Vitale MG. Factors affecting distal end & global decompensation in coronal/sagittal planes 2 years after fusion. Stud Health Technol Inform 2010; 158:141-146. [PMID: 20543414] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
INTRODUCTION Decompensation of un-fused vertebrae is a potential complication of spinal instrumentation performed for adolescent idiopathic scoliosis (AIS). This can result in problems requiring revision surgery. The purpose of this study was to compare patients who decompensated in the sagittal/coronal plane and those who do not and to identify risk factors. METHODS The Spinal Deformity Study Group data-base for AIS identified 908 patients at 2 years post-op. Coronal measures analyzed included coronal balance (CB), coronal position of the lower instrumented vertebra (CPL) and LIV tilt angle (LTA). Sagittal measures included sagittal balance (SB) and distal-junctional kyphosis (DJK). The incidence of decompensation at 2 years was: CB-16.83%, LTA-37.53%, CPL-21.17%, negative SB-51.88%, positive SB-7.62%, DJK-6.8%. Decompensated patients were compared to those who were not using preoperative, and 4-16 weeks post-op values. RESULTS Numerous significant differences were found between patients who decompensated at 2 years and those who did not. CB was significantly influenced by larger height/weight, increased Cobb, preexisting CB and a thoracic LIV. In addition to other factors LTA decompensation was more likely to occur in JIS. CPL was associated with pelvic-obliquity and thoracic LIV. Post-operative sagittal balance could be predicted by pre-operative sagittal balance. DJK was also associated with larger weight and preoperative sagittal measures. DISCUSSION AND CONCLUSION Less correction in sagittal/coronal planes is a risk factor for decompensation. Curve correction was significant in predicting coronal decompensation. Failure to control sagittal alignment was a risk factor in sagittal decompensation.
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Affiliation(s)
- Daniel J Miller
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, NY, USA
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Vitale MG, Moore DW, Matsumoto H, Emerson RG, Booker WA, Gomez JA, Gallo EJ, Hyman JE, Roye DP. Risk factors for spinal cord injury during surgery for spinal deformity. J Bone Joint Surg Am 2010; 92:64-71. [PMID: 20048097 DOI: 10.2106/jbjs.h.01839] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Spinal cord monitoring is now considered standard care during surgery for spinal deformity. Combined somatosensory and motor evoked potential monitoring allows the detection of early spinal cord dysfunction in most patients. The purpose of the current study was to identify clinical factors that increase the risk of intraoperative electrophysical changes and to provide management recommendations. METHODS The records of 162 consecutive patients who underwent surgery for the treatment of spinal deformity at a tertiary referral center were reviewed. Electrophysical monitoring of these patients was considered to have been successful if reproducible signals had been obtained. Relevant electrophysical changes included a reduction, as compared with baseline, of >50% in the amplitude of the somatosensory evoked potentials; an increase, as compared with baseline, of >10% in the latency of the somatosensory evoked potentials; a loss of motor evoked potentials; and an abrupt decrease of >75% in the motor evoked potentials. RESULTS One hundred and fifty-one (93%) of the 162 patients were monitored successfully. Four of the eleven patients with unsuccessful monitoring had neuromuscular scoliosis. Twelve of the 151 successfully monitored patients had a true electrophysical event, and two of them were found to have new postoperative neurologic deficits that represented a change from the findings of their preoperative neurologic examination. The determined causes of these electrophysical events included curve correction in eight patients, hypotension in two, direct cord trauma in one, and malposition of a pedicle screw in one. The patients with a true electrophysical event had a significantly higher rate of neurologic events than did the patients who did not have a true electrophysical event (p < 0.001). The rate of true electrophysical events was significantly higher in the patients with cardiopulmonary comorbidities than it was in the patients with no comorbidities (p = 0.011). CONCLUSIONS Combined somatosensory and motor evoked potential monitoring effectively prevents neurologic injury in most children undergoing surgery for spinal deformity. Despite the potential for false-positive results, we recommend setting a low threshold for defining relevant electrophysical changes. Rapid intervention can reverse these changes and avoid potentially serious neurologic complications. Patients with cardiopulmonary comorbidities may be at a higher risk for having relevant electrophysical events.
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Affiliation(s)
- Michael G Vitale
- Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, 3959 Broadway, Room 800 North, New York, NY 10032, USA.
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Vitale MG, Roye BD, Ruchelsman DE, Roye DP. Preoperative use of recombinant human erythropoietin in pediatric orthopedics: a decision model for long-term outcomes. Spine J 2007; 7:292-300. [PMID: 17482112 DOI: 10.1016/j.spinee.2006.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [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] [Received: 07/15/2005] [Revised: 11/15/2005] [Accepted: 04/07/2006] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Spine surgery for scoliosis is associated with significant blood loss and may require blood transfusion. The risks inherent in blood transfusion have inspired interventions, including human recombinant erythropoietin (rHuEPO), which has emerged as a safe and effective adjunct in minimizing exposure to allogenic blood in children undergoing scoliosis surgery. However, there is little information in the literature on their economic impact on the health-care system. PURPOSE The purpose of this study was to evaluate the cost-effectiveness of rHuEPO in adolescent idiopathic scoliosis. STUDY DESIGN/SETTING We designed a decision analytic model capturing costs and potential long-term outcomes of transfusion-related complications to compare the cost-effectiveness of preoperative rHuEPO with a control group and a common alternative, preoperative autologous donation (PAD). PATIENT SAMPLE This is a decision analytic model. Decision modeling relies on a summation of the probability of different clinical studies; no patients were specifically studied. OUTCOME MEASURES The standard cost-effectiveness ratio (C/E) of $50,000 per quality-adjusted life year (QALY) was used as the threshold value for determining the cost-effectiveness of these two preoperative intervention strategies. METHODS From the model we calculated the probability that a patient would experience transfusion-related complications based on the mean number of allogenic units transferred as a result of scoliosis surgery. The standard C/E of $50,000 per QALY was used as the threshold value for determining the cost-effectiveness. Some aspects of the model were derived from retrospective data from the literature. Sensitivity analyses were also conducted to discover which variables, when changed within the accepted range, caused the final result of the model to change significantly. RESULTS Results indicated a cost per year-of-life-saved exceeding $1 million for the PAD arm and over $1.5 million for the rHuEPO arm. The low rates of transfusion in adolescent idiopathic scoliosis surgery and the relative safety of the blood supply create a scenario where even inexpensive interventions are not cost-effective. However, rHuEPO would become cost-effective if decreased transfusion rates or higher postoperative hematocrit resulted in decreased length of stay. CONCLUSION The use of rHuEPO preoperatively and the use of PAD are not cost-effective although both techniques remain clinically effective tools.
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Affiliation(s)
- Michael G Vitale
- Columbia University and New York Presbyterian Hospital, 600 W. 168th Street, 7th Floor, New York, NY 10032, USA.
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Vitale MG, Matsumoto H, Kessler MW, Hoffmann W, Roye DP. Osteogenesis imperfecta: determining the demographics and the predictors of death from an inpatient population. J Pediatr Orthop 2007; 27:228-32. [PMID: 17314652 DOI: 10.1097/bpo.0b013e31803179e2] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [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: 02/07/2023]
Abstract
Osteogenesis imperfecta is a heritable disease that may result in bone fragility, increased joint laxity, decreased muscle tone, thinning of the skin, a bluish appearance of the sclerae, and scoliosis in as many as 60% of cases. The purpose of this study was to examine the impact of patient and hospital characteristics on mortality rate during inpatient stays. Data was collected retrospectively from the Healthcare Cost and Utilization Project Kids' Inpatient Database, a resource designed to analyze pediatric hospital usage. Data were collected from 1793 patients in the 27 states. Overall, 3% of this population died during hospitalization. Self-pay patients, patients in hospitals with small bed sizes, patients in non pediatric hospitals, and younger patients all had higher mortality rates than did their counterparts. In addition, black patients were 3.7 times more likely to die than did patients of any other race, and women were more likely to die than did men, although more than half of the number of patients were classified as white and 52% were men. Although these trends suggest that the mortality of younger patients may be reduced by admittance to children's hospitals, the children who are hospitalized younger tend to have more severe forms of the disease and are therefore more deformed and more difficult to treat. Overall, the results of this study indicate that children with osteogenesis imperfecta who need hospitalization may benefit from being referred to a large children's hospital, and that there is further research needed into the significant differences in the mortality of black patients and female patients.
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Affiliation(s)
- Michael G Vitale
- Pediatric Orthopaedic Surgery, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University Medical Center, New York, NY, USA.
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Lowenstein JE, Matsumoto H, Vitale MG, Weidenbaum M, Gomez JA, Lee FYI, Hyman JE, Roye DP. Coronal and sagittal plane correction in adolescent idiopathic scoliosis: a comparison between all pedicle screw versus hybrid thoracic hook lumbar screw constructs. Spine (Phila Pa 1976) 2007; 32:448-52. [PMID: 17304136 DOI: 10.1097/01.brs.0000255030.78293.fd] [Citation(s) in RCA: 187] [Impact Index Per Article: 11.0] [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: 02/01/2023]
Abstract
STUDY DESIGN This was a retrospective cohort study using a previously matched convenience sample of 34 patients. OBJECTIVE This study sought to determine the relative corrective benefits of these 2 types of constructs in the correction of coronal and sagittal curves in patients with adolescent idiopathic scoliosis (AIS). In addition, the 2 constructs were compared for coronal and sagittal balance. SUMMARY OF BACKGROUND INFORMATION Recent clinical research suggests that thoracic pedicle screw constructs (all-screw constructs) are more effective than hybrid lumbar screw thoracic hook constructs (hybrid constructs) in correcting spine deformity. METHODS The sample consisted of patients with AIS who underwent isolated posterior spinal fusion and instrumentation. Seventeen patients underwent fusion using all-screw constructs, and 17 underwent fusion with hybrid constructs; preoperative and postoperative radiographs and measurements were compared. RESULTS There was no significant difference observed when comparing the 2 groups, although there was a trend toward better correction of the main thoracic curve in the all-screw construct group (P = 0.089). In the all-screw group, mean thoracic kyphosis decreased from 29.6 degrees to 19.4 degrees (P = 0.012). Sagittal balance changed in the hybrid group from -21.2 mm to 8.2 mm, and in the all-screw group changed from -28.8 mm to 1.5 mm. The major curve in the hybrid group improved from 54.06 degrees to 20.25 degrees and improved from 54.88 degrees to 15.06 degrees in the all-screw group. CONCLUSIONS There was no statistically significant difference comparing the 2 groups, although a trend was observed toward better correction of the main thoracic curve in the all-screw construct group. The all-screw group demonstrated a significant decrease in kyphosis, which was not seen in the hybrid group. Hybrid constructs were comparable to all-screw constructs in the correction of coronal plane deformity and sagittal balance.
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Affiliation(s)
- Jason E Lowenstein
- Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Medical Center, New York, NY, USA
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Abstract
PURPOSE The purpose of this study is to report the current incidence rates of pediatric spinal cord injury (SCI) in the United States and identify specific high-risk populations as a knowledge basis for improving the prevention and treatment of this traumatic injury. METHODS The Kids' Inpatient Database (KID) and the National Trauma Data Bank (NTDB) were used to investigate the etiology of pediatric SCI. RESULTS Significant differences in the annual incidence rate of pediatric SCI were found to exist between patient populations stratified by race and sex. African Americans (1.53 cases/100,000 children) exhibit a significantly higher rate of pediatric SCI than native Americans (1.00), Hispanics (0.87), and Asians (0.36), whereas Asians show a significantly lower incidence than all other races. Also, boys (2.79) are more than twice as likely to experience SCI as girls (1.15). The overall incidence of pediatric SCI in the United States is 1.99 cases per 100,000 children. From these data, it is estimated that 1455 children are admitted to US hospitals each year for treatment of SCI. The etiology of pediatric SCI was also investigated, and the major causative factors were identified: motor vehicle accident (56%), accidental fall (14%), firearm injury (9%), and sports injury (7%). Of those children injured in a motor vehicle accident, 67.7% (n = 107) were reported as not wearing a seatbelt. The role of alcohol and drugs was also investigated and found to be involved in 30% (n = 82) of all pediatric SCI cases. CONCLUSIONS Using discharge records from a public database, it is possible to identify high-risk demographic groups and activities that predispose a child to SCI. With a more thorough understanding of the etiology of pediatric SCI, clinicians and parents are better equipped to devise measures for prevention and treatment of this injury.
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Affiliation(s)
- Michael G Vitale
- Division of Pediatric Orthopaedics, Department of Orthopaedic Surgery, Columbia University, College of Physicians and Surgeons, New York, NY, USA.
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Vitale MG, Vitale MA, Lehmann CL, Hyman JE, Roye DP, Skaggs DL, Schmitz ML, Sponseller PD, Flynn JM. Towards a National Pediatric Musculoskeletal Trauma Outcomes Registry: the Pediatric Orthopaedic Trauma Outcomes Research Group (POTORG) experience. J Pediatr Orthop 2006; 26:151-6. [PMID: 16557126 DOI: 10.1097/01.bpo.0000218520.98244.37] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [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: 02/07/2023]
Abstract
This study is a pilot effort towards the broader implementation of a national pediatric musculoskeletal trauma outcomes registry. The primary goal of this project is to explore the feasibility of a web-based data acquisition and management platform and to identify catalysts and obstacles to multi-center collaboration. A prospective cohort of children presenting to the Pediatric Emergency Departments with ankle, femur, supracondylar humerus, tibial spine, or open fractures at five clinical centers between October 2001 and March 2003 comprised the study population. Patients were enrolled via the treating orthopaedic resident, using a web-based data acquisition and management system. Orthopaedic attendees were sent an automated reminder to complete a follow-up form one week after treatment, and parents of enrolled children were sent child and parent health questionnaires by e-mail and mail in order to capture health-related quality of life and post-traumatic stress symptoms. A total of 299 patients were enrolled in the study with an average age of 7.3 years. Post-treatment follow-up questionnaires were completed by 39% of the attending orthopaedic surgeons, and by 43% of the enrolled patients or patient's parents. Children old enough to complete health questionnaires scored lower in 5 of 12 functional domains including Physical Function, Role/Social Emotional/Behavioral, Parental Impact-Emotional, Family Activities, and Family Cohesion. Within the subset of patients sustaining femur fractures whose parents completed health questionnaires, 9.5% reported significant post-traumatic stress symptoms. This study demonstrates the potential of a multi-center web-based registry to facilitate the collection of a rich array of pediatric trauma, treatment and patient-based outcomes data, although new regulatory issues regarding patient privacy pose challenges to such an approach.
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Affiliation(s)
- Michael G Vitale
- International Center for Health Outcomes and Innovation Research, College of Physicians and Surgeons and The Joseph L. Mailman School of Public Health, Columbia University and Columbia Presbyterian Hospital, New York, NY, USA.
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Abstract
Measuring quality of life (QOL) in a population with a functional range as large as that of the pediatric cerebral palsy population is challenging. This study assessed the utility of two common QOL instruments in this population: the Child Health Questionnaire (CHQ) and the Pediatric Outcomes Data Collection Instrument (PODCI). The goal was to determine the efficacy of these questionnaires in detecting subtle differences in the QOL among children with cerebral palsy and to demonstrate the need for dynamic assessment when evaluating QOL within this group. There were 180 subjects between the ages of 5 and 18 years, split into three diagnostic groups-diplegic, hemiplegic, and quadriplegic. The PODCI was more sensitive to differences in the diplegic and hemiplegic groups, but quadriplegics exhibited a floor effect (50% or more scored at most 15 out of 100) in three of the five domains. The CHQ was more effective for the quadriplegic group, but the diplegic and hemiplegic diagnostic groups exhibited a ceiling effect on 2 of the 12 domains in that questionnaire. Because an instrument that uses dynamic assessment bases subsequent questions on the patient's response to the first ones, dynamic assessment would help to avoid ceiling and floor effects by asking questions more pertinent to the patient's actual condition, and it would save time that would have been wasted answering irrelevant questions about function and QOL.
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Affiliation(s)
- Michael G Vitale
- International Center for Health Outcomes and Innovation Research.
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Lee FYI, Sinicropi SM, Lee FS, Vitale MG, Roye DP, Choi IH. Treatment of congenital pseudarthrosis of the tibia with recombinant human bone morphogenetic protein-7 (rhBMP-7). A report of five cases. J Bone Joint Surg Am 2006; 88:627-33. [PMID: 16510831 DOI: 10.2106/jbjs.d.02201] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Francis Young-In Lee
- Department of Orthopaedic Surgery, Children's Hospital of New York, Columbia University, New York, NY, USA.
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Vitale MA, Choe JC, Sesko AM, Hyman JE, Lee FY, Roye DP, Vitale MG. The effect of limb length discrepancy on health-related quality of life: is the '2 cm rule' appropriate? J Pediatr Orthop B 2006; 15:1-5. [PMID: 16280711 DOI: 10.1097/01202412-200601000-00001] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [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: 02/10/2023]
Abstract
The primary goal of surgical equalization of lower extremity limb length discrepancy is to enhance the quality of life of patients by improving their function, gait, appearance, and pain secondary to compensation for the limb length discrepancy. While many surgeons use a cutoff point of 2 cm as an indication for intervention, little attention has been given to the effect of limb length discrepancy on quality of life. Therefore, the purpose of this study was to determine the relationship between limb length discrepancy and health-related quality of life and to assess whether the commonly accepted 2 cm cutoff serves to predict patients with and without quality of life perturbations. The Child Health Questionnaire was used to collect information from the parents of 76 children diagnosed with limb length discrepancy, and these data were compared with data from scanograms. Differences in quality of life became more apparent with increasing limb length discrepancy, especially among psychosocial health domains. As expected, patients with a limb length discrepancy of 2 cm or below generally fared better than patients with larger discrepancies, but no discrete cutoff could be identified within this group.
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Affiliation(s)
- Mark A Vitale
- Columbia University, College of Physicians and Surgeons, New York, New York, USA
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Vitale MA, Heyworth BE, Skaggs DL, Roye DP, Lipton CB, Vitale MG. Comparison of the volume of scoliosis surgery between spine and pediatric orthopaedic fellowship-trained surgeons in New York and California. J Bone Joint Surg Am 2005; 87:2687-2692. [PMID: 16322618 DOI: 10.2106/jbjs.d.01825] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [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: 02/01/2023]
Abstract
BACKGROUND Controversy exists regarding the optimal fellowship training experience for surgeons who perform scoliosis surgery in pediatric patients. While many studies have demonstrated that higher surgical volumes are associated with superior outcomes, the volume of scoliosis procedures performed by pediatric orthopaedic-trained surgeons as opposed to spine surgery-trained surgeons has not been reported. METHODS Validated, statewide hospital discharge databases from the states of New York and California were utilized to examine the volume of spinal fusion procedures performed for the treatment of scoliosis in patients who were eighteen years of age or less. Fellowship training of surgeons in New York who had performed more than fifty procedures from 1992 to 2001 (that is, more than five procedures per year) was determined, and the operative volumes of surgeons who had received pediatric orthopaedic as opposed to spine fellowship training were compared. Hospitals in California with either type of fellowship program were identified, and the operative volumes of hospitals and fellows with pediatric orthopaedic or spine fellowship training from 1995 to 1999 were compared. RESULTS Among the 228 surgeons in New York who had performed one or more spinal fusion procedures in patients eighteen years of age or less from 1992 to 2001, only 13% (thirty) had performed more than five procedures per year. However, these thirty surgeons accounted for 75% (3858) of all 5136 procedures in this age-group. Surgeons who had completed a pediatric orthopaedic fellowship had performed a mean of 14.5 procedures per physician per year, whereas those who had completed a spine fellowship had performed a mean of 10.5 procedures per physician per year. Surgeons who had not completed either type of fellowship had performed a mean of 14.4 procedures per physician per year. In California, the mean annual volume of scoliosis procedures from 1995 to 1999 was 59.0 procedures per year at hospitals with pediatric orthopaedic fellowship programs and 15.7 procedures per year at those with spine surgery programs. The mean number of procedures per fellow at hospitals with pediatric orthopaedic fellowship programs was 31.6 procedures per fellow per year, and the mean number at hospitals with spine surgery programs was 12.7 procedures per fellow per year. Over time, there was a significant increase in the number of procedures per year at hospitals with both types of fellowship programs, but the percentage increase was greater for hospitals with pediatric orthopaedic fellowship programs than for hospitals with spine surgery fellowship programs (45.2% compared with 13.5%). CONCLUSIONS These data indicate that, on the average, a large number of surgeons in New York performed five scoliosis procedures per year or fewer. Among higher-volume surgeons in New York, those with pediatric orthopaedic fellowship training performed more scoliosis procedures on children and adolescents than those with orthopaedic spine training did. In California, the volume of scoliosis procedures at hospitals with pediatric orthopaedic fellowship programs was nearly four times greater than that at hospitals with spine fellowship programs and the volume of procedures per fellow was more than two times greater, and this disparity is widening over time. These data are an important element in establishing what type of fellowship best prepares surgeons for scoliosis surgery.
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Affiliation(s)
- Mark A Vitale
- Columbia College of Physicians and Surgeons, Columbia University, 630 West 168th Street, Mailbox #400, New York, NY 10032
| | - Benton E Heyworth
- Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021
| | - David L Skaggs
- University of Southern California, Children's Orthopaedic Center, Children's Hospital of Los Angeles, 4650 Sunset Boulevard #69, Los Angeles, CA 90027
| | - David P Roye
- Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia College of Physicians and Surgeons, Columbia University, 600 West 168th Street, 7th Floor, New York, NY 10032
| | - Carter B Lipton
- Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia College of Physicians and Surgeons, Columbia University, 600 West 168th Street, 7th Floor, New York, NY 10032
| | - Michael G Vitale
- Division of Pediatric Orthopaedic Surgery, Department of Orthopaedic Surgery, Columbia College of Physicians and Surgeons, Columbia University, 600 West 168th Street, 7th Floor, New York, NY 10032.
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Abstract
This retrospective study was undertaken to determine the effectiveness and cost of thoracic pedicle screws versus laminar and pedicle hooks in patients undergoing surgical correction of adolescent idiopathic scoliosis (AIS). Immediate preoperative and 6-week postoperative radiographs were examined in 25 consecutive cases of children with AIS who were divided into two groups, those with thoracic pedicle screw constructs and those with thoracic hook constructs. Endpoints collected included radiographic measures, complications, surgical time, implant cost, and quality-of-life measures. Ten children underwent spinal fusion using thoracic pedicle screw fixation and 15 underwent thoracic constructs composed of hooks. Similar sex and age distribution were noted in both groups, and among the 20 girls and 5 boys the average age was 14.5. The mean preoperative Cobb angle was 53.5 degrees for the screw group and 52.5 degrees for the hook group. Correction averaged 70.2% for the screw group and 68.1% for the hook group. There were no significant differences between the two patient groups in terms of percentage of or absolute curve change after surgery. The apical vertebral translation, end vertebral tilt angle, and coronal balance did not differ significantly between the two patient groups. Comparison of operative time and quality of life revealed no significant differences. Screw constructs were significantly more expensive than hook constructs. The correction obtained from thoracic pedicle screw fixation is comparable to traditional hook constructs in AIS. Surgery using either construct effectively corrects AIS.
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Affiliation(s)
- Stephen K Storer
- Columbia University and the Children's Hospital of New York, NY, USA
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Abstract
The ongoing controversy regarding the appropriate treatment of clubfoot has resulted in much variability in practice patterns, making the assessment of long-term outcomes a difficult one. Recently, new patient-based measures of outcomes have allowed for improved methods of assessing health outcomes in children. The purpose of this study was to follow up on a cohort of adolescents who underwent surgical repair at the authors' institution. Traditional (radiographs) and patient-based measures were obtained from 24 patients. The Child Health Questionnaire showed that the quality of life of these patients was relatively high after surgery, and these scores were comparable to those of age-matched young athletes with healthy feet. The disease-specific instrument, which was also administered, showed similar results. The role of radiographic measures was limited, as they did not reflect patient-based outcomes after clubfoot surgery. Both generic and disease-specific measures should be used as primary endpoints in evaluating treatment results in this area.
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Affiliation(s)
- Michael G Vitale
- International Center for Health Outcomes and Innovation Research, College of Physicians and Surgeons and the Joseph L. Mailman School of Public Health, Columbia University and New York Presbyterian Hospital, New York, New York, USA.
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Vitale MA, Arons RR, Hyman JE, Skaggs DL, Roye DP, Vitale MG. The contribution of hospital volume, payer status, and other factors on the surgical outcomes of scoliosis patients: a review of 3,606 cases in the State of California. J Pediatr Orthop 2005; 25:393-9. [PMID: 15832162 DOI: 10.1097/01.bpo.0000153880.05314.be] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [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: 02/07/2023]
Abstract
While volume/outcomes relationships have been shown for several areas of orthopaedics, previous studies have not examined this relationship in the area of scoliosis surgery. The Office of Statewide Planning and Development (OSHPD) California inpatient discharge database was used for a retrospective review of all patients 25 years of age or younger with a diagnosis of scoliosis and a spinal fusion procedure from 1995 to 1999 (n = 3,606). Univariate and multivariate analyses were conducted to determine the effect of various factors on in-hospital mortality, surgical complications, reoperations, and length of stay (LOS). Univariate analyses revealed significant effects of age, sex, illness severity, neuromuscular disease, surgical approach, Medicaid status, and annual hospital volume on outcomes (P < 0.05). After controlling for these factors using multivariate regression, patients insured by Medicaid were found to have a significantly greater odds for complications (P = 0.017) and a significantly increased LOS (P < 0.001) compared with patients with all other sources of payment. Additionally, multivariate regression revealed an inverse relationship between annual hospital volume and likelihood of reoperation, as patients treated at hospitals with annual volumes of 5.1 to 25.0, 25.1 to 50.0, and greater than 50.0 spinal fusions all had approximately half the odds of reoperation (P = 0.042, P = 0.004, and P = 0.028 respectively) as patients treated at hospitals with an annual volume of 5.0 or fewer spinal fusions per year. The current data suggest that being insured with Medicaid in the state of California is associated with poorer outcomes after scoliosis surgery. Additionally, this study documents a volume/outcomes relationship in scoliosis surgery.
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Affiliation(s)
- Mark A Vitale
- International Center for Health Outcomes and Innovation Research (InCHOIR) and the Mailman School of Public Health, Columbia University, New York, NY, USA
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