Blog Archive
In 1998, Dr. Oheneba Boachie-Adjei, an orthopaedic surgeon at the Hospital for Special Surgery in New York, established the Foundation of Orthopedics and Complex Spine (FOCOS) and started medical mission trips to Ghana to provide spinal deformity care. Since then, >500 volunteers have accompanied Dr. Boachie...
TB infection of the spine classically presents as Pott disease. Other presentations include tuberculous arachnoiditis, nonosseous spinal tuberculoma, and spinal meningitis. In North America, Cascino and Dibble provided one of the first descriptions of a patient with intradural TB that developed after medical treatment had been...
Introduction The Scoliosis Research Society (SRS) questionnaire is a well-establishedand validated 24-item survey that evaluates the different domains of health-related quality of life (HRQOL), including pain, individual self-image, activity level, physical function, and personal satisfactionin scoliosis patients. Since its development, the SRS has subsequently been modified...
Posterior fixation in conjunction with bone grafting is the standard technique to achieve bony fusion in lumbar spinal surgery. Pedicle screw fixation in the lumbar spine is the most commonly used method of posterior lumbar fusion.1,2 This technique provides three-column support of the vertebrae, contributing to...
Pre-donation of autologous blood prior to spine fusion for adolescent idiopathic scoliosis (AIS) has been used in deformity surgery. The eRect of pre-donation on pre-operative hematocrit (Hct) remains debated. Multiple factors may inQuence pre-operative Hct including intravascular volume status, patient factors, and timing of pre-operative blood...
Background Multilevel spinal fusion surgery has typically been associated with significant blood loss and transfusion requirements. Significant patient factors affecting operative blood loss include duration of exposure, severity and type of spinal deformity, patient weight, and gender. 1-3 Surgery dependent factors include operating time, procedure performed,...
Hallux valgus (HV) is a first ray forefoot deformity characterized by varus alignment of the first metatarsal and lateral deviation of the great toe, resulting in a medial prominence of the first metatarsal head. It often causes pain, difficulty with normal shoe wear, and loss of...
Progression of idiopathic scoliosis correlates with skeletal growth, peaks during the adolescent growth spurt, and usually stabilizes or slows at skeletal maturity. 1 The predictors of skeletal maturity guide the treatment of idiopathic scoliosis by envisaging the risk and timing of curve progression. The maturity indicators...
DORSAL THORACOLUMBAR INSTRUMENTATION In 1975, the Harrington rod represented the state of the art in spinal instrumentation. The rod system, originally developed by Paul Harrington for the correction of spinal deformities, was soon used in the treatment of traumatic injuries1,2 (Fig. 3-1), degenerative disease,3 and metastatic...
The two most common etiologies of back pain and radiculopathy are herniation of the nucleus pulposus and degenerative changes of the spine and neuroforamen1 . Of the myriad causes of nerve compression that lead to radiculopathy, vascular etiologies remain among the most infrequent, with an estimated...
Perioperative blood loss is a major concern in surgery, particularly in complex, high-risk surgical procedures such as adult spinal deformity correction. Although recent advances including autologous blood donation, erythropoietin, and cell saver have been employed to reduce perioperative bleeding and maintain blood volume, patients nevertheless have...
Tuberculosis (TB), the disease caused by Mycobacterium tuberculosis, is the second leading killer worldwide from a single infectious agent. Spinal TB is associated with pulmonary disease and may originate from (1) hematogenous spread outside the central nervous system (CNS), (2) sites located within the cranium (meningitis), or (3) secondary extension...
Inroduction Abdominal compartment syndrome (ACS) is an unpredictable complication of posterior spinal fusion surgery. The condition is defined by elevated intra-abdominal compartment pressure (IAP) O 20 mm Hg, resulting in physiologic compromise and end organ dysfunction [1]. Abdominal compartment syndrome can result from trauma, extreme fluid...
Surgical management of spinal deformity is associated with significant blood loss and transfusion requirements. Patient factors affecting operative blood loss include the severity and type of spinal deformity, and patient height [1-3]. Surgery-dependent factors include operative time, duration of exposure, procedure performed, surgical approach, number...
Despite efforts to improve infection rates, surgical site infection remains a burdensome complication of spinal surgery. Postoperative spinal wound infections lead to increased morbidity and mortality, increased hospital stay or rehospitalization, and additional cost.1 Reported rates of surgical site infection in the literature range from less...
Degenerative changes in the cervical spine causing symptomatic myelopathy and/or radiculopathy are common indications for anterior cervical decompression and fusion (ACDF). ACDF has a disease-free survival rate of 86% at 5 years and is considered the gold standard to treat these conditions.1 Despite the success of...
Neuromuscular scoliosis (NMS) is commonly defined as a scoliotic deformity arising secondarily to muscle imbalance caused by an underlying neuropathic or myopathic disease. Generally, spinal deformities secondary to neuromuscular pathology present early in life and progress rapidly.1 In children and adolescents with neuromuscular disease, the incidence...
Symptomatic myelopathy and/or radiculopathy are common indications for surgical intervention in the cervical spine. Anterior cervical decompression and fusion (ACDF) is considered to be the “gold standard” to treat these conditions with adjacent-level degeneration-free rates of 86% at 5 years. 1 Although successful, the incidence...
Multilevel spinal fusion has been well established as the primary approach for the surgical correction of adolescent idiopathic scoliosis (AIS).1–7 Significant intraoperative and postoperative blood loss has typically been associated with spinal fusion surgery.2,8,9 Excessive intraoperative and postoperative blood loss increases the transfusion burden on the...
Introduction The treatment of adolescent idiopathic scoliosis (AIS) is based on the ability to reduce truncal deformity, limit curve progression, and improve quality of life. Because AIS does not lead to increased mortality [1], successful treatment outcomes are often dependent on improvements in healthrelated quality...
The use of anterior approaches for spinal fusion for the treatment of adolescent idiopathic scoliosis (AIS) has been debated because of the concern that pulmonary function is compromised with procedures that violate the chest wall. Although both anterior and posterior spinal approaches have been indicated...
Anterior spinal approaches have been indicated for thoracolumbar curves in adolescent idiopathic scoliosis (AIS).1,2 These approaches facilitate large coronal curve correction and derotation, short segment fusions, saving of distal levels, and reduced operative blood loss. Recent evidence suggests, however, that approach-related pulmonary function impairment may...
The choice of bone graft for lumbar spinal arthrodesis takes many factors into consideration. Achieving a successful fusion is the primary goal when selecting a graft; however, other considerations that contribute to bone graft selection include patient morbidity related to autograft harvest at various...
The decision to undergo corrective surgery for scoliosis is one that is shared between the physician, the patient, and the family. Although physicians can rely on results of scientific studies that have been published in peer-reviewed journals, patients neither have the medical background to understand...
Background Multilevel spinal fusion surgery has typically been associated with significant blood loss and transfusion requirements. Significant patient factors affecting operative blood loss include duration of exposure, severity and type of spinal deformity, and patient height [1-3]. Surgery dependent factors include operating time, procedure performed, combined...
The Scoliosis Research Society (SRS) Instrument was developed by Haher et al in 1999 to assess postoperative patient outcome in adolescents with idiopathic scoliosis (AIS).1 This 24-item questionnaire assesses different domains of health related quality of life (HRQOL) including pain, general self-image, general function, level of...