1
|
Hanstein R, Schneble CA, Schulz JF, Lo Y, Socci AR, Sharkey MS. The Effect of Guided Growth Surgery on Langenskiold Stage and Mechanical Axis in Early-Onset Blount Disease: A Retrospective Case Series. J Am Acad Orthop Surg 2024; 32:e240-e250. [PMID: 37852243 DOI: 10.5435/jaaos-d-21-00515] [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] [Received: 04/28/2021] [Accepted: 08/16/2023] [Indexed: 10/20/2023] Open
Abstract
INTRODUCTION Our understanding of the efficacy of guided growth surgery with tension-band plating (TBP) in early-onset Blount disease is evolving. Preliminary work has demonstrated that TBP can normalize the mechanical axis, yet its effect on Langenskiöld stage (LS) has not previously been reported. The primary outcome of this study was improvement in LS after TBP. Secondary outcomes were improvement in LS at most recent follow-up and improvement in mechanical axis deviation (MAD), mechanical medial proximal tibial angle, and mechanical lateral distal femoral angle at treatment completion and most recent follow-up. METHODS A retrospective review was done of patients with early-onset Blount disease treated with TBP between January 1, 2010, and December 31, 2019, across two institutions. Inclusion criteria were a radiographic diagnosis of early-onset Blount disease (LS changes present), surgery with TBP, and follow-up beyond implant removal. Radiographs before surgery, at removal of hardware (ROH), and at most recent follow-up were evaluated. RESULTS Twenty-five limbs in 16 children who underwent TBP at a mean age of 5.8 ± 2.3 years were included. Implants were in situ a mean of 1.9 ± 0.7 years. The mean follow-up after ROH was 3.6 ± 1.4 years. LS ranged from 1 to 5 preoperatively with 14 of 25 limbs (56%) staged ≥3. LS improved in 15 of 25 limbs (60%) at ROH and in 21 of 25 limbs (84%) at most recent follow-up. Langenskiöld changes resolved in 7 of 25 limbs (28%) at most recent follow-up. Preoperatively, the MAD was varus in all limbs, but at ROH, the MAD had improved in 22 of 23 limbs with neutral or valgus alignment in 20 of 23 limbs (87%). At most recent follow-up, 16 of 23 limbs (70%) maintained improved alignment. DISCUSSION There was improvement/resolution of LS and varus deformity in early-onset Blount disease in most patients who underwent TBP. Based on these results, TBP for early-onset Blount disease should be the first-line surgical treatment. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Regina Hanstein
- From the Department of Cardiology, Mt. Sinai Health System, New York, NY (Hanstein), Department of Orthopaedic Surgery, Children's Hospital at Montefiore Medical Center, Bronx, NY (Schulz and Sharkey), Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT (Schneble and Socci), and Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY (Lo)
| | | | | | | | | | | |
Collapse
|
2
|
Younis MH, Hanstein R, Javed K, Fornari ED, Gomez JA, Sharkey MS, Schulz JF. Does Combining Drilling and Curettage to Percutaneous Trans-epiphyseal Screws Improve Correction of Limb Length Discrepancy? A Comparative Study. Indian J Orthop 2024; 58:190-198. [PMID: 38312896 PMCID: PMC10831026 DOI: 10.1007/s43465-023-01070-7] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Accepted: 11/21/2023] [Indexed: 02/06/2024]
Abstract
Objectives Physeal drilling and curettage (PDC) and percutaneous epiphysiodesis using transphyseal screws (PETS) are among the most widely used techniques to treat leg-length discrepancy (LLD). This study compared the efficacy and outcomes between PETS alone and PETS combined with PDC (PETS + PDC). Methods Retrospective study of children who underwent epiphysiodesis of the proximal tibia or distal femur with either PETS or PETS + PDC between 2008 and 2018 at a single institution. Radiographic parameters and complications were reviewed at completion of treatment and most recent follow-up. Results A total of 23 epiphysiodeses in 15 patients, average age 13.1 years, with either PETS (13 femur/tibias) or PETS + PDC (10 femur/tibias) were included. PETS patients were treated for a longer time (median: 24 months vs 11 months, p = 0.004), however, follow-up time was similar between groups (p = 0.577), on average 2.7 years. In the PETS group, LLD decreased from 2.55 to 0.84 cm at most recent follow-up (p = 0.010), and in the PETS + PDC group from 3.01 to 1.2 cm (p = 0.005), achieving a correction of 1.71 cm for PETS and 1.83 cm for PETS + PDC (p = 0.871). A correction of LLD to ≤ 2 cm was achieved in 8 PETS (89%) and 4 PETS + PDC cases (67%) (p = 0.525). Two PETS patients (22%) and 1 PETS + PDC (17%) patient returned to the OR for further correction due to persistent LLD (p = 1.000). No differences existed in total number of complications, angular deformity or return to physical activity between groups (p ≥ 0.05 for each comparison). Conclusions This study showed equal efficiency in resolving LLD between the PETS and PETS + PDC procedures with minimal operative complications.Level of Evidence III.
Collapse
Affiliation(s)
| | - Regina Hanstein
- Division of Pediatric Orthopaedics, Children’s Hospital at Montefiore Medical Center, Bronx, NY USA
| | | | - Eric D. Fornari
- Division of Pediatric Orthopaedics, Children’s Hospital at Montefiore Medical Center, Bronx, NY USA
| | - Jaime A. Gomez
- Division of Pediatric Orthopaedics, Children’s Hospital at Montefiore Medical Center, Bronx, NY USA
| | - Melinda S. Sharkey
- Division of Pediatric Orthopaedics, Children’s Hospital at Montefiore Medical Center, Bronx, NY USA
| | - Jacob F. Schulz
- Division of Pediatric Orthopaedics, Children’s Hospital at Montefiore Medical Center, Bronx, NY USA
| |
Collapse
|
3
|
Segal KR, Gomez JA, Schulz JF, Alvandi LM, Fornari ED. The Impact of Standardized Recovery Pathways on Language Barriers and Inpatient Pain Management. Hosp Pediatr 2023; 13:1001-1009. [PMID: 37850258 DOI: 10.1542/hpeds.2023-007232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
BACKGROUND AND OBJECTIVES Inpatient postoperative care is reliant upon clear, open communication between providers and patient-families, and thus is particularly vulnerable to disparities when discordant languages exist. It is not yet understood how standardized postoperative protocols may mitigate disparities related to language discordance. METHODS This is a retrospective cohort study among adolescent idiopathic scoliosis patients who underwent posterior spinal fusion at a tertiary care children's hospital in Bronx, New York after implementation of a postoperative pathway in 2017. Outcomes reliant upon communication between patient-families and providers were measured, including measures of pain management (number and type of pain medications requested, daily pain assessments, total opioids consumed), as well as outpatient pain scores. RESULTS A total of 160 patients were included (39 language other than English [LOE]). Between patient cohorts, there were no significant differences in demographic or operative characteristics. On univariate analyses, LOE patients were more likely to be given a basal dosing of patient-controlled analgesia or additional boluses (26% vs 12%, P = .03), consumed 0.53 fewer benzodiazepine medications per day (P = .01), and were more likely to have pain at outpatient follow-up (67% vs 43%, P = .03). On multivariate analyses, LOE patients were more likely to be placed on basally dosed or receive additional boluses of patient-controlled analgesia (odds ratio 3.19, 95% confidence interval 1.15-8.85). CONCLUSIONS As standardized pathways become more common in health care, it is critical to monitor for components of these protocols that may be vulnerable to language-related disparities, such as therapies reliant on symptom description and outpatient follow-up.
Collapse
|
4
|
Karkenny AJ, Avarello J, Hanstein R, Lo Y, Burlage A, Crabb R, McNally K, Merwin S, Schulz JF, Poon S. Pediatric Fractures: Does Vitamin D Play a Role? J Pediatr Orthop 2023:01241398-990000000-00315. [PMID: 37390504 DOI: 10.1097/bpo.0000000000002462] [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: 07/02/2023]
Abstract
BACKGROUND Vitamin D (25-OHD) deficiency and insufficiency are reported in about half of all children. The literature on low 25-OHD and pediatric fracture risk presents inconsistent results. This study evaluates the association between pediatric fractures and 25-OHD, parathyroid hormone (PTH), and calcium. METHODS This is a prospective case-control study in 2 urban pediatric emergency departments (2014-2017). Patients aged 1 to 17 requiring intravenous access were enrolled. Demographics, nutrition, and activity information were recorded and levels of 25-OHD, calcium, and PTH were measured. RESULTS Two hundred forty-five subjects were enrolled: 123 fractures and 122 controls. Overall, the mean 25-OHD level was 23 ng/mL±8.5: 52 (21%) of patients were 25-OHD sufficient; 193 (79%) were not. Ninety-six percent of patients with lower extremity fractures had low 25-OHD versus 77% of patients with upper extremity fractures (P=0.024). The fracture cohort was younger (P=0.002), included more males (P=0.020), and spent more time playing outdoor sports (P=0.011) than the control cohort. The 25-OHD level (fracture 22.8 ng/mL±7.6 vs. nonfracture 23.5 ng/mL±9.3, P=0.494) and median calcium level (fracture 9.8 mg/dL vs. nonfracture 10.0 mg/dL, P=0.054) were similar between cohorts. The median PTH level was higher in the fracture than the control cohort (33 vs. 24.5 pg/mL; P<0.0005); PTH was elevated to hyperparathyroidism (>65 pg/mL) in 13% of fractures and 2% of controls (P=0.006). Matched subgroup analysis of 81 fracture patients and 81 controls by age, gender, and race showed that PTH was the only variable independently associated with increased odds of fracture (odds ratio=1.10, 95% CI, 1.01-1.19, P=0.021) in a model adjusted for vitamin D sufficiency and time spent playing outdoor sports. CONCLUSIONS Low 25-OHD is common in children with fractures but we found no difference in 25-OHD levels between fracture and nonfracture cohorts. This research can impact evidence-based guidelines on vitamin D level screening and/or supplementation after fracture. LEVEL OF EVIDENCE Diagnostic level IV-case-control study.
Collapse
Affiliation(s)
| | | | | | - Yungtai Lo
- Albert Einstein College of Medicine, Bronx
| | - Ashley Burlage
- Northwell Health Orthopaedic Institute at Huntington, Huntington
| | - Rocio Crabb
- Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY
| | | | | | | | - Selina Poon
- Shriners Hospital for Children, Pasadena, CA
| |
Collapse
|
5
|
Quaife NM, Chothani S, Schulz JF, Lindberg EL, Vanezis K, Adami E, O'Fee K, Greiner J, Litviňuková M, van Heesch S, Whiffin N, Hubner N, Schafer S, Rackham O, Cook SA, Barton PJR. LINC01013 Is a Determinant of Fibroblast Activation and Encodes a Novel Fibroblast-Activating Micropeptide. J Cardiovasc Transl Res 2023; 16:77-85. [PMID: 35759180 PMCID: PMC9944705 DOI: 10.1007/s12265-022-10288-z] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 06/09/2022] [Indexed: 10/17/2022]
Abstract
Myocardial fibrosis confers an almost threefold mortality risk in heart disease. There are no prognostic therapies and novel therapeutic targets are needed. Many thousands of unannotated small open reading frames (smORFs) have been identified across the genome with potential to produce micropeptides (< 100 amino acids). We sought to investigate the role of smORFs in myocardial fibroblast activation.Analysis of human cardiac atrial fibroblasts (HCFs) stimulated with profibrotic TGFβ1 using RNA sequencing (RNA-Seq) and ribosome profiling (Ribo-Seq) identified long intergenic non-coding RNA LINC01013 as TGFβ1 responsive and containing an actively translated smORF. Knockdown of LINC01013 using siRNA reduced expression of profibrotic markers at baseline and blunted their response to TGFβ1. In contrast, overexpression of a codon-optimised smORF invoked a profibrotic response comparable to that seen with TGFβ1 treatment, whilst FLAG-tagged peptide associated with the mitochondria.Together, these data support a novel LINC01013 smORF micropeptide-mediated mechanism of fibroblast activation. TGFβ1 stimulation of atrial fibroblasts induces expression of LINC01013, whose knockdown reduces fibroblast activation. Overexpression of a smORF contained within LINC01013 localises to mitochondria and activates fibroblasts.
Collapse
Affiliation(s)
- N M Quaife
- National Heart and Lung Institute, Imperial College London, London, UK
- MRC London Institute of Medical Sciences, London, UK
| | - S Chothani
- Program in Cardiovascular and Metabolic Disorders, Duke-National University of Singapore, Singapore, 169857, Singapore
| | - J F Schulz
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- DZHK (German Center for Cardiovascular Research), partner site Berlin, Berlin, Germany
| | - E L Lindberg
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - K Vanezis
- National Heart and Lung Institute, Imperial College London, London, UK
- MRC London Institute of Medical Sciences, London, UK
| | - E Adami
- Program in Cardiovascular and Metabolic Disorders, Duke-National University of Singapore, Singapore, 169857, Singapore
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - K O'Fee
- MRC London Institute of Medical Sciences, London, UK
| | - J Greiner
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - M Litviňuková
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
| | - S van Heesch
- Princess Máxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - N Whiffin
- National Heart and Lung Institute, Imperial College London, London, UK
- Cardiovascular Research Centre, Royal Brompton and Harefield Hospitals, Guy's and St Thomas NHS Foundation Trust, London, UK
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - N Hubner
- Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany
- DZHK (German Center for Cardiovascular Research), partner site Berlin, Berlin, Germany
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - S Schafer
- Program in Cardiovascular and Metabolic Disorders, Duke-National University of Singapore, Singapore, 169857, Singapore
| | - O Rackham
- Program in Cardiovascular and Metabolic Disorders, Duke-National University of Singapore, Singapore, 169857, Singapore
| | - S A Cook
- MRC London Institute of Medical Sciences, London, UK
- Program in Cardiovascular and Metabolic Disorders, Duke-National University of Singapore, Singapore, 169857, Singapore
- National Heart Centre Singapore, Singapore, Singapore
| | - P J R Barton
- National Heart and Lung Institute, Imperial College London, London, UK.
- MRC London Institute of Medical Sciences, London, UK.
- Cardiovascular Research Centre, Royal Brompton and Harefield Hospitals, Guy's and St Thomas NHS Foundation Trust, London, UK.
| |
Collapse
|
6
|
Joshi T, Berman DC, Baghdadi S, Mostafa E, Gomez JA, Hanstein R, Alvandi LM, Schulz JF. Pre-operative prone radiographs can reliably determine spinal curve flexibility in adolescent idiopathic scoliosis (AIS). Spine Deform 2022; 10:1063-1070. [PMID: 35570256 DOI: 10.1007/s43390-022-00517-5] [Citation(s) in RCA: 1] [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: 11/29/2021] [Accepted: 04/24/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the correlation between non-effort prone and bending radiographs in determining curve flexibility in adolescent idiopathic scoliosis (AIS). METHODS A retrospective review of AIS patients who underwent pre-operative full spine radiographic imaging from 2006 to 2019 was performed. The Cobb angle (CA) of proximal thoracic (PT), main thoracic (MT) and thoracolumbar/lumbar (TL/L) curves were measured and correlated on standing, prone and bending radiographs. Standing, bending, and prone measurements were correlated using Spearman's analysis, and intra-rater reliability was evaluated using intraclass correlation analysis. RESULTS A total of 381 patients (74% female) with a mean age of 15.1 ± 2.5 years were identified. A strong correlation existed between the prone and bending CA for the PT (rs = 0.797, p < 0.01) and MT (rs = 0.779, p < 0.01) curve and a moderate correlation existed between the prone and bending TL/L curve (rs = 0.641, p < 0.01). For a non-structural PT curve, a prone CA < 25° correctly identified a bending CA < 25° 96.7% of the time (p < 0.005). For a non-structural MT curve, a prone CA < 35° correctly identified a bending CA < 25° 90.2% of the time (p < 0.005). For a non-structural TL/L curve, a prone CA < 35° correctly identified a bending CA < 25° 95% of the time (p < 0.005). CONCLUSION Prone radiographs demonstrated a moderate to strong correlation with bending radiographs and may be used as a proxy for determining spinal flexibility, especially when bending films are deemed unreliable. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Tej Joshi
- Division of Pediatric Orthopaedics, Department of Orthopaedic Surgery, Children's Hospital at Montefiore Medical Center, 3400 Bainbridge Ave, 6th floor, Bronx, NY, 10467, USA
| | - Daniel C Berman
- Department of Orthopaedic Surgery, Montefiore Medical Center, Bronx, NY, 10467, USA
| | - Soroush Baghdadi
- Division of Pediatric Orthopaedics, Department of Orthopaedic Surgery, Children's Hospital at Montefiore Medical Center, 3400 Bainbridge Ave, 6th floor, Bronx, NY, 10467, USA
| | - Evan Mostafa
- Albert Einstein College of Medicine, Bronx, NY, 10461, USA
| | - Jaime A Gomez
- Division of Pediatric Orthopaedics, Department of Orthopaedic Surgery, Children's Hospital at Montefiore Medical Center, 3400 Bainbridge Ave, 6th floor, Bronx, NY, 10467, USA
| | - Regina Hanstein
- Division of Pediatric Orthopaedics, Department of Orthopaedic Surgery, Children's Hospital at Montefiore Medical Center, 3400 Bainbridge Ave, 6th floor, Bronx, NY, 10467, USA
| | - Leila Mehraban Alvandi
- Division of Pediatric Orthopaedics, Department of Orthopaedic Surgery, Children's Hospital at Montefiore Medical Center, 3400 Bainbridge Ave, 6th floor, Bronx, NY, 10467, USA
| | - Jacob F Schulz
- Division of Pediatric Orthopaedics, Department of Orthopaedic Surgery, Children's Hospital at Montefiore Medical Center, 3400 Bainbridge Ave, 6th floor, Bronx, NY, 10467, USA.
| |
Collapse
|
7
|
Younis MH, Hanstein R, Javed K, Fornari ED, Gomez JA, Sharkey MS, Schulz JF. Percutaneous epiphysiodesis using transphyseal screws (PETS) versus tension-band plating (TBP): comparative study of outcomes for correcting limb length discrepancy. Eur J Orthop Surg Traumatol 2022:10.1007/s00590-022-03304-0. [PMID: 35723838 DOI: 10.1007/s00590-022-03304-0] [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] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 05/28/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The best effective treatment strategy for limb length discrepancy (LLD) is still being debated. The goal of this study was to compare the efficacy and results of tension-band plating (TBP) and percutaneous epiphysiodesis using transphyseal screws (PETS) for LLD correction. METHODS From June 2008 to January 2019, children who had lower extremity epiphysiodesis with either TBP or PETS were reviewed retrospectively. At the conclusion of treatment, LLD, angular deformity, and complications were reviewed. The t-test or Wilcoxon rank sum test was used to compare continuous variables. Categorical variables were evaluated using Fisher's exact test or χ2 test. RESULTS A total of 32 epiphysiodeses with TBP (14 patients, 24 femur/tibias) or PETS (13 patients, 23 femur/tibias) were compared. TBPs were conducted while the patients were younger (11.0 vs. 13.1 years, p = 0.005). The treatment durations were similar in both groups (TBP: 23.5 months vs. PETS: 24 months, p = 0.132). PETS had significantly shorter operative time (p = 0.047), length of hospital stay (p = 0.014), and time to return to full activity (p = 0.043). LLD in the TBP group reduced from 2.64 to 1.38 cm (p = 0.005), while in the PETS group it decreased from 2.76 to 1.08 cm (p = 0.001). During treatment, the rate of LLD correction was 0.49 ± 0.9 cm/year for limbs treated with TBP and 1.0 ± 1.1 cm/year for limbs treated with PETS (p = 0.185). At the end of treatment, 8 TBP cases (47%) and 9 PETS cases (60%) had achieved LLD ≤ 2 cm (p = 0.502), and at the most recent follow-up, this had grown to 11 (65%) in the TBP group and 12 (80%) in the PETS group. There were no significant differences in the total number of complications between groups (p > 0.05). Revision surgery was required in 11 TBP and 3 PETS limbs due to persistent LLD or angular deformity (AD) (p = 0.016). Logistic regression did not reveal any significant association between TBP and the rate of complication or revision surgery. CONCLUSION PETS and TBP are both effective methods for limb length equalization. PETS, on the other hand, was linked to a shorter operative time, a shorter hospital stay, a faster recovery to pre-operative function, and a lower complication rate. The rate of revision surgery due to persistent LLD or AD was higher in TBP. We advise surgeons against utilizing TBP to correct LLD. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
- Manaf H Younis
- Division of Pediatric Orthopaedics, Children's Hospital at Montefiore Medical Center, Bronx, NY, USA.
| | - Regina Hanstein
- Division of Pediatric Orthopaedics, Children's Hospital at Montefiore Medical Center, Bronx, NY, USA
| | | | - Eric D Fornari
- Division of Pediatric Orthopaedics, Children's Hospital at Montefiore Medical Center, Bronx, NY, USA
| | - Jaime A Gomez
- Division of Pediatric Orthopaedics, Children's Hospital at Montefiore Medical Center, Bronx, NY, USA
| | - Melinda S Sharkey
- Division of Pediatric Orthopaedics, Children's Hospital at Montefiore Medical Center, Bronx, NY, USA
| | - Jacob F Schulz
- Division of Pediatric Orthopaedics, Children's Hospital at Montefiore Medical Center, Bronx, NY, USA
| |
Collapse
|
8
|
Abstract
PURPOSE This article examines if longer posterior spinal fusions with instrumentation (PSFI) into the lumbar spine (L3/4) alter spinopelvic parameters compared with selective fusions to T12/L1/L2 in adolescent idiopathic scoliosis (AIS) patients. METHODS We analysed radiographs of 84 AIS patients, 58 (69%) females and 26 (31%) males, who underwent PSFI at an mean age of 15 years ± 2.5 years, range 10 years to 21 years, between 1st January 2007 and 31st December 2014. Radiographic parameters were measured pre- and post-operatively at most recent follow-up (range 2 years to 8.2 years): pelvic incidence (PI), lumbar lordosis (LL, L1-S1 and L4-S1), sagittal vertical alignment (SVA), scoliosis angle and proximal junctional kyphosis (PJK). PI-LL was calculated. Data was analysed using t-tests or Wilcoxon rank-sum tests. RESULTS In total, 32 patients underwent a selective fusion with lowest instrumented vertebra (LIV) T12-L2, and 52 patients underwent a fusion with LIV L3-L4. In both groups, scoliosis angle was significantly corrected at follow-up (p < 0.005).Pre-operatively, both groups had similar LL (L1-S1) and PI-LL. Post-operatively, LL increased in the L3-4 fusion group (p < 0.005) but did not change in the selective fusion group (p = 0.116). This change in LL in the L3-4 fusion group affected the post-operative PI-LL (T12-L2 fusion -4.9° versus L3-4 fusion -13.6°, p = 0.002). No differences were seen in PI, SVA or LL L4-S1 between groups. Radiographic PJK occurred in seven of the L3-4 patients with and without PJK (noPJK -8.8° versus PJK -25.8°, p = 0.026). CONCLUSIONS In patients who underwent a fusion ending at L3 or L4, LL was increased. This altered the PI-LL relationship, and appeared to increase the risk of PJK. LEVEL OF EVIDENCE III.
Collapse
Affiliation(s)
| | - Alexa J. Karkenny
- Division of Pediatric Orthopaedics, Children’s Hospital at Montefiore Medical Center, Medical Arts Pavilion, Bronx, New York, USA
| | - Jacob F. Schulz
- Division of Pediatric Orthopaedics, Children’s Hospital at Montefiore Medical Center, Medical Arts Pavilion, Bronx, New York, USA
| | - Regina Hanstein
- Division of Pediatric Orthopaedics, Children’s Hospital at Montefiore Medical Center, Medical Arts Pavilion, Bronx, New York, USA
| | - Jaime A. Gomez
- Division of Pediatric Orthopaedics, Children’s Hospital at Montefiore Medical Center, Medical Arts Pavilion, Bronx, New York, USA,Correspondence should be sent to Jaime A. Gomez, Medical Arts Pavilion, 3400 Bainbridge Avenue, Bronx, NY 10467, USA. E-mail:
| |
Collapse
|
9
|
Schulz JF, Molho DA, Sylvia SM, Lo Y, Gomez JA, Moloney CM, Hanstein R, Fornari ED. Parental understanding of intoeing gait - A preliminary study. Foot (Edinb) 2019; 41:39-43. [PMID: 31683095 DOI: 10.1016/j.foot.2019.06.004] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 06/11/2019] [Accepted: 06/25/2019] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Evaluation of a child's intoeing gait is one of the most common referrals made to a pediatric orthopedist. Families may have difficulty understanding the often transient and usually benign nature of intoeing. The purpose of this study was to investigate parental perceptions of an intoeing gait both before and after consultation with an orthopedic practitioner. METHODS 48 parents of children referred to pediatric orthopedic surgeons for evaluation of intoeing gait completed a 22-item questionnaire that assessed demographics, anxiety, and parental perceptions of intoeing. Questionnaires were administered before and after visits. Statistical analysis was performed using Wilcoxon signed-rank tests and Fisher exact tests. RESULTS Before their visits, parents reported similar levels of anxiety and understanding regarding intoeing, independent of their age or education. After the visits, anxiety decreased (P < 0.001), and understanding increased (P < 0.001) although younger parents (18-25 years) reported higher post-visit anxiety compared to parents older than 25 (P = 0.014). Similarly, parents with a high school degree or less reported higher post-visit anxiety compared to parents who attended college (P = 0.009). Post-visit understanding was inversely correlated with post-visit anxiety (r = -0.717; P < 0.001). Additionally, parents who reported high anxiety post-visit stated they were more likely to seek additional care (P < 0.001). CONCLUSIONS Younger parents with lower education levels were more likely to leave visits with high anxiety and poor understanding. These parents were more likely to consider seeking further treatment for their child's intoeing, placing additional stress on their child, themselves and an overburdened healthcare system.
Collapse
Affiliation(s)
- Jacob F Schulz
- Division of Pediatric Orthopaedics, Children's Hospital at Montefiore Medical Center, 3400 Bainbridge Avenue, Bronx, NY 10467, USA.
| | - David A Molho
- Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, USA.
| | - Stephen M Sylvia
- Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, USA.
| | - Yungtai Lo
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, USA.
| | - Jaime A Gomez
- Division of Pediatric Orthopaedics, Children's Hospital at Montefiore Medical Center, 3400 Bainbridge Avenue, Bronx, NY 10467, USA.
| | - Christine M Moloney
- Division of Pediatric Orthopaedics, Children's Hospital at Montefiore Medical Center, 3400 Bainbridge Avenue, Bronx, NY 10467, USA.
| | - Regina Hanstein
- Division of Pediatric Orthopaedics, Children's Hospital at Montefiore Medical Center, 3400 Bainbridge Avenue, Bronx, NY 10467, USA.
| | - Eric D Fornari
- Division of Pediatric Orthopaedics, Children's Hospital at Montefiore Medical Center, 3400 Bainbridge Avenue, Bronx, NY 10467, USA.
| |
Collapse
|
10
|
Herman MJ, Brown KO, Sponseller PD, Phillips JH, Petrucelli PM, Parikh DJ, Mody KS, Leonard JC, Moront M, Brockmeyer DL, Anderson RCE, Alder AC, Anderson JT, Bernstein RM, Booth TN, Braga BP, Cahill PJ, Joglar JM, Martus JE, Nesiama JAO, Pahys JM, Rathjen KE, Riccio AI, Schulz JF, Stans AA, Shah MI, Warner WC, Yaszay B. Pediatric Cervical Spine Clearance: A Consensus Statement and Algorithm from the Pediatric Cervical Spine Clearance Working Group. J Bone Joint Surg Am 2019; 101:e1. [PMID: 30601421 DOI: 10.2106/jbjs.18.00217] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [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: 02/01/2023]
Affiliation(s)
- Martin J Herman
- Orthopedic Center for Children, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania
| | - Kristin O Brown
- Orthopedic Center for Children, St. Christopher's Hospital for Children, Philadelphia, Pennsylvania
| | - Paul D Sponseller
- Department of Orthopedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | | | - Philip M Petrucelli
- Department of Orthopedic Surgery (P.M.P.), Drexel University College of Medicine (D.J.P., and K.S.M.), Hahnemann University Hospital, Philadelphia, Pennsylvania
| | - Darshan J Parikh
- Department of Orthopedic Surgery (P.M.P.), Drexel University College of Medicine (D.J.P., and K.S.M.), Hahnemann University Hospital, Philadelphia, Pennsylvania
| | - Kush S Mody
- Department of Orthopedic Surgery (P.M.P.), Drexel University College of Medicine (D.J.P., and K.S.M.), Hahnemann University Hospital, Philadelphia, Pennsylvania
| | - Julie C Leonard
- Division of Emergency Medicine, Department of Pediatrics, The Ohio State University College of Medicine, and Nationwide Children's Hospital, Columbus, Ohio
| | - Matthew Moront
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Douglas L Brockmeyer
- Department of Neurological Surgery, University of Utah, Primary Children's Hospital, Salt Lake City, Utah
| | - Richard C E Anderson
- Department of Neurosurgery, Columbia University, Morgan Stanley Children's Hospital of NewYork-Presbyterian, New York, NY
| | - Adam C Alder
- Division of Pediatric Surgery, Department of Surgery (A.C.A.), Departments of Radiology (T.N.B., and J.M.J.) and Neurological Surgery and Pediatrics (B.P.B.), and Division of Emergency Medicine, Department of Pediatrics (J.-A.O.N.), University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
| | - John T Anderson
- Department of Orthopedic Surgery, Children's Mercy and University of Missouri-Kansas City School of Medicine, Kansas City, Missouri
| | - Robert M Bernstein
- Department of Orthopedics, Cedars-Sinai Medical Center, Los Angeles, California
| | - Timothy N Booth
- Division of Pediatric Surgery, Department of Surgery (A.C.A.), Departments of Radiology (T.N.B., and J.M.J.) and Neurological Surgery and Pediatrics (B.P.B.), and Division of Emergency Medicine, Department of Pediatrics (J.-A.O.N.), University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
| | - Bruno P Braga
- Division of Pediatric Surgery, Department of Surgery (A.C.A.), Departments of Radiology (T.N.B., and J.M.J.) and Neurological Surgery and Pediatrics (B.P.B.), and Division of Emergency Medicine, Department of Pediatrics (J.-A.O.N.), University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
| | - Patrick J Cahill
- Division of Orthopedic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jeanne M Joglar
- Division of Pediatric Surgery, Department of Surgery (A.C.A.), Departments of Radiology (T.N.B., and J.M.J.) and Neurological Surgery and Pediatrics (B.P.B.), and Division of Emergency Medicine, Department of Pediatrics (J.-A.O.N.), University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
| | - Jeffrey E Martus
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jo-Ann O Nesiama
- Division of Pediatric Surgery, Department of Surgery (A.C.A.), Departments of Radiology (T.N.B., and J.M.J.) and Neurological Surgery and Pediatrics (B.P.B.), and Division of Emergency Medicine, Department of Pediatrics (J.-A.O.N.), University of Texas Southwestern Medical Center at Dallas, Dallas, Texas
| | - Joshua M Pahys
- Shriners Hospitals for Children, Philadelphia, Pennsylvania
| | - Karl E Rathjen
- Department of Orthopedic Surgery, Texas Scottish Rite Hospital for Children, Dallas, Texas
| | - Anthony I Riccio
- Department of Orthopedic Surgery, Texas Scottish Rite Hospital for Children, Dallas, Texas
| | - Jacob F Schulz
- Department of Orthopedic Surgery, The Children's Hospital at Montefiore, Bronx, New York
| | - Anthony A Stans
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Manish I Shah
- Section of Emergency Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - William C Warner
- Department of Orthopedic Surgery, University of Tennessee - Campbell Clinic and Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Burt Yaszay
- Department of Orthopedics, Rady Children's Hospital and University of California-San Diego Medical Center, San Diego, California
| |
Collapse
|
11
|
De la Garza Ramos R, Schulz JF, Gomez JA, Yassari R. Editorial on "Increased radiation but no benefits in pedicle screw accuracy with navigation versus a freehand technique in scoliosis surgery". J Spine Surg 2018; 4:660-662. [PMID: 30547134 DOI: 10.21037/jss.2018.09.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Rafael De la Garza Ramos
- Spine Research Group, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jacob F Schulz
- Department of Orthopaedic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jaime A Gomez
- Department of Orthopaedic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Reza Yassari
- Spine Research Group, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA.,Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| |
Collapse
|
12
|
Berko NS, Hanstein R, Burton DA, Fornari ED, Schulz JF, Levin TL. Ultrasound elastography of the patellar tendon in young, asymptomatic sedentary and moderately active individuals. Clin Imaging 2018; 54:172-177. [PMID: 30190095 DOI: 10.1016/j.clinimag.2018.08.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 08/19/2018] [Accepted: 08/24/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND The recent use of ultrasound elastography to study patellar tendon softness has demonstrated increased tendon softness in high-level athletes. We hypothesized that measurable alterations in patellar tendon softness may be present in young asymptomatic subjects engaging in moderate levels of physical activity. METHODS This was a cross-sectional study. Gray-scale ultrasound and ultrasound elastography of the right and left patellar tendons were performed in young asymptomatic sedentary subjects and moderately active subjects who engaged in at least 30 min of physical activity 4-5 times weekly. The distribution of soft, intermediate and stiff tissue within each tendon was analyzed. Tendon softness was correlated with subject age, gender and level of athletic activity. RESULTS Sixty patellar tendons in 30 subjects were evaluated (18 males, 12 females, mean age 22.5 years). Seventeen subjects were defined as "active" and 13 as "sedentary." All tendons had a normal gray-scale sonographic appearance. Tendon softness was significantly higher in active subjects (P = 0.01) and decreased with age (P = 0.04). In sedentary individuals there was no significant correlation between age and tendon softness (P = 0.404). Similarly, gender showed no correlation with tendon softness (P > 0.05). CONCLUSIONS Patellar tendon softness is higher in young subjects and in those engaging in moderate physical activity. This may reflect an adaptation to increased tendon load. Tendon softness in active subjects decreases with age, while it remains at a constant value in sedentary individuals. LEVEL OF EVIDENCE Level 3.
Collapse
Affiliation(s)
- Netanel S Berko
- University of Pennsylvania, Department of Radiology, 3400 Spruce Street, Philadelphia, PA 19104, United States of America.
| | - Regina Hanstein
- Children's Hospital at Montefiore, Division of Pediatric Orthopaedics, 3400 Bainbridge Ave, Bronx, NY 10467, United States of America
| | - Denver A Burton
- Albert Einstein College of Medicine, 1300 Morris Park, Bronx, NY 10461, United States of America
| | - Eric D Fornari
- Children's Hospital at Montefiore, Division of Pediatric Orthopaedics, 3400 Bainbridge Ave, Bronx, NY 10467, United States of America
| | - Jacob F Schulz
- Children's Hospital at Montefiore, Division of Pediatric Orthopaedics, 3400 Bainbridge Ave, Bronx, NY 10467, United States of America
| | - Terry L Levin
- Montefiore Medical Center, Department of Radiology, 111 E 210th St, Bronx, NY 10467, United States of America
| |
Collapse
|
13
|
De la Garza Ramos R, Nakhla J, Nasser R, Schulz JF, Purvis TE, Sciubba DM, Kinon MD, Yassari R. Effect of body mass index on surgical outcomes after posterior spinal fusion for adolescent idiopathic scoliosis. Neurosurg Focus 2017; 43:E5. [DOI: 10.3171/2017.7.focus17342] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVEObesity is an increasing public health concern in the pediatric population. The purpose of this investigation was to examine the impact of body mass index (BMI) on 30-day outcomes after posterior spinal fusion for adolescent idiopathic scoliosis (AIS).METHODSThe American College of Surgeons National Surgical Quality Improvement Program Pediatric database (2013 and 2014) was reviewed. Patients 10–18 years of age who had undergone fusion of 7 or more spinal levels for AIS were included. Thirty-day outcomes (complications, readmissions, and reoperations) were compared based on patient BMI per age- and sex-adjusted growth charts as follows: normal weight (NW; BMI < 85th percentile), overweight (OW; BMI 85th–95th percentile), and obese (OB; BMI > 95th percentile).RESULTSPatients eligible for study numbered 2712 (80.1% female and 19.9% male) and had a mean age of 14.4 ± 1.8 years. Average BMI for the entire cohort was 21.9 ± 5.0 kg/m2; 2010 patients (74.1%) were classified as NW, 345 (12.7%) as OW, and 357 (13.2%) as OB. The overall complication rate was 1.3% (36/2712). For NW and OW patients, the complication rate was 0.9% in each group; for OB patients, the rate was 4.2% (p < 0.001). The 30-day readmission rate was 2.0% (55/2712) for all patients, 1.6% for NW patients, 1.2% for OW patients, and 5.0% for OB patients (p < 0.001). The 30-day reoperation rate was 1.4% (39/2712). Based on BMI, this reoperation rate corresponded to 0.9%, 1.2%, and 4.8% for NW, OW, and OB patients, respectively (p < 0.001). After controlling for patient age, number of spinal levels fused, and operative/anesthesia time on multiple logistic regression analysis, obesity remained a significant risk factor for complications (OR 4.61), readmissions (OR 3.16), and reoperations (OR 5.33; all p < 0.001).CONCLUSIONSBody mass index may be significantly associated with short-term outcomes after long-segment fusion procedures for AIS. Although NW and OW patients may have similar 30-day outcomes, OB patients had significantly higher wound complication, readmission, and reoperation rates and longer hospital stays than the NW patients. The findings of this study may help spine surgeons and patients in terms of preoperative risk stratification and perioperative expectations.
Collapse
Affiliation(s)
| | - Jonathan Nakhla
- 1Spine Research Group
- Departments of 2Neurological Surgery and
| | - Rani Nasser
- 1Spine Research Group
- Departments of 2Neurological Surgery and
| | - Jacob F. Schulz
- 3Orthopedic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, New York; and
| | - Taylor E. Purvis
- 4Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Daniel M. Sciubba
- 4Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Reza Yassari
- 1Spine Research Group
- Departments of 2Neurological Surgery and
| |
Collapse
|
14
|
Berko NS, Mehta AK, Levin TL, Schulz JF. Effect of knee position on the ultrasound elastography appearance of the patellar tendon. Clin Radiol 2015; 70:1083-6. [PMID: 26264499 DOI: 10.1016/j.crad.2015.06.100] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 06/18/2015] [Accepted: 06/30/2015] [Indexed: 10/23/2022]
Affiliation(s)
- N S Berko
- Department of Radiology, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA.
| | - A K Mehta
- Department of Radiology, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA
| | - T L Levin
- Department of Radiology, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA
| | - J F Schulz
- Department of Orthopaedic Surgery, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA
| |
Collapse
|
15
|
Levy BJ, Schulz JF, Fornari ED, Wollowick AL. Complications associated with surgical repair of syndromic scoliosis. Scoliosis 2015; 10:14. [PMID: 25949273 PMCID: PMC4422098 DOI: 10.1186/s13013-015-0035-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Accepted: 02/13/2015] [Indexed: 11/23/2022]
Abstract
Background There are a number of syndromes that have historically been associated with scoliosis e.g.: Marfan, Down, and Neurofibromatosis. These syndromes have been grouped together as one etiology of scoliosis, known as syndromic scoliosis. While multiple studies indicate that these patients are at high risk for perioperative complications, there is a paucity of literature regarding the collective complication rates and surgical needs of this population. Methods PubMed and Embase databases were searched for literature encompassing the surgical complications associated with the surgical management of patients undergoing correction of scoliosis in the syndromic scoliosis population. Following exclusion criteria, 24 articles were analyzed for data regarding these complications. Results The collective complication rates and findings of these articles were categorized based on specific syndrome. The rates and types of complications for each syndrome and the special needs of patients with each syndrome are discussed. Several complication trends of note were observed, including but not limited to the universally nearly high rate of wound infections (>5% in each group), high rate of pulmonary complications in patients with Rett syndrome (29.2%), high rate (>10%) of dural tears in Marfan and Ehlers-Danlos syndrome patients, high rate (>20%) of implant failure in Down and Prader-Willi syndrome patients, and high rate (>25%) of pseudarthrosis in Down and Ehlers-Danlos patients. Conclusions Though these syndromes have been classically grouped together under the umbrella term “syndromic,” there may be specific needs for patients with each of these ailments. Given the high rate of complications, further research is necessary to understand the unique needs for each of these patient groups in the preoperative, intraoperative, and postoperative settings.
Collapse
Affiliation(s)
- Benjamin J Levy
- Montefiore Medical Center and Albert Einstein College of Medicine, 1250 Waters Place, 11th Floor, Bronx, NY 10461 USA
| | - Jacob F Schulz
- Montefiore Medical Center and Albert Einstein College of Medicine, 1250 Waters Place, 11th Floor, Bronx, NY 10461 USA
| | - Eric D Fornari
- Montefiore Medical Center and Albert Einstein College of Medicine, 1250 Waters Place, 11th Floor, Bronx, NY 10461 USA
| | - Adam L Wollowick
- Orthopaedic Surgery, Albert Einstein College of Medicine, Bronx, USA
| |
Collapse
|
16
|
Schulz JF, Chambers HG. Juvenile osteochondritis dissecans of the knee: current concepts in diagnosis and management. Instr Course Lect 2013; 62:455-467. [PMID: 23395050] [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: 06/01/2023]
Abstract
Osteochondritis dissecans of the knee is a diagnosis that encompasses a wide spectrum of pathologies that can result in irreversible damage to articular cartilage and subchondral bone. Osteochondritis dissecans was first described more than 100 years ago, and despite substantial research on the topic, large gaps remain in the understanding of its etiology and optimal treatment. An underlying vascular insult, resulting in separation of the progeny lesion from the parent subchondral bone, is a suspected cause but remains unproven. No single standardized classification exists to accurately predict long-term risk. Nonsurgical treatment with activity modification remains an option for stable lesions in young patients. Surgical treatment to encourage vascular ingrowth and healing is gaining popularity and represents a shift in thinking regarding the risk of disease progression. Unstable and displaced lesions remain a difficult treatment challenge. Various salvage procedures have shown promise, but the potential for long-term morbidity remains.
Collapse
|
17
|
Handal JA, Schulz JF, Florez GB, Kwok SCM, Khurana JS, Samuel SP. Creation of rabbit bone and soft tissue tumor using cultured VX2 cells. J Surg Res 2012; 179:e127-32. [PMID: 22475353 DOI: 10.1016/j.jss.2012.02.061] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Revised: 02/27/2012] [Accepted: 02/29/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND To create rabbit VX2 bone tumors, it is surgically less demanding to implant VX2 cell suspensions than minced tumor fragments. A VX2 cell line that can be expanded using standard cell culture techniques might provide an unlimited supply of cells needed to create these bone tumors. Therefore, the aim of the present study was to establish a VX2 cell line and verify its tumorigenicity in an athymic mouse and rabbit animal model. MATERIALS AND METHODS Minced VX2 tumor fragments were allowed to grow as a monolayer in 10 mL Dulbecco's modified Eagle medium/nutrient mixture F-12 (1:1) supplemented with 10% fetal calf serum and passaged multiple times. The tumorigenecity of the cultured VX2 cells were tested in athymic mice (intradermal tumor development) and in New Zealand white rabbits (bone and soft tissue tumor model). RESULTS The VX2 cells proliferated rapidly in tissue culture flasks containing Dulbecco's modified Eagle medium/nutrient mixture F-12 medium supplemented with 10% fetal bovine serum. After reaching confluence, the VX2 cells can only be subcultured when plated at a greater density (e.g., at a dilution of 1:1). All 6 athymic mice developed tumors within 15 d of VX2 cell suspension implantation. In the rabbits, the VX2 cells were able to produce tumors in muscle tissue and in the distal femurs but not in the proximal tibia. CONCLUSIONS VX2 cell lines can be successfully created from VX2 tumor fragments and passaged multiple times. In contrast to previous reports, the VX2 cells grown in vitro are capable of maintaining their tumorigenecity. However, successful tumor growth might depend on the initial number of cells implanted and the use of extracellular matrices for tumor proliferation.
Collapse
Affiliation(s)
- John A Handal
- Department of Orthopedic Surgery, Einstein Medical Center, Philadelphia, Pennsylvania 19141, USA,
| | | | | | | | | | | |
Collapse
|
18
|
Handal JA, Schulz JF, Pahys JM, Williams EA, Kwok SC, Samuel SP. Evaluation of Elution and Mechanical Properties of Two Injectable Chemotherapeutic Bone Cements. Chemotherapy 2011; 57:268-74. [DOI: 10.1159/000327388] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Accepted: 12/13/2010] [Indexed: 11/19/2022]
|