This fall I had the wonderful opportunity to be interviewed by Heather Banks and Heidi Selzler-Bahr for the Gustavus Health Professions Podcast. This was impactful for me as Gustavus Adolphus College in St. Peter, Minnesota is my alma mater. This small, Lutheran, liberal arts college (about 90 minutes from Minneapolis) and provided me the opportunity […]
Year: 2021
New publication comparing MAGEC Growing Rods, Posterior Spinal Fusion and Vertebral Body Tether in 8-11 year old scoliosis patients
Spine (Phila Pa 1976). 2021 Oct 1. doi: 10.1097/BRS.0000000000004245. Online ahead of print. Magnetically Controlled Growing Rods (MCGR) Versus Single Posterior Spinal Fusion (PSF) Versus Vertebral Body Tether (VBT) in Older Early Onset Scoliosis (EOS) Patients: How Do Early Outcomes Compare? Catherine Mackey 1, Regina Hanstein, Yungtai Lo, Majella Vaughan, Tricia St Hilaire, Scott J Luhmann, Michael G Vitale, Michael P Glotzbecker, Amer Samdani, Stefan Parent, Jaime […]
Talking Points between Surgeon and Patient/Family about Thoracic Vertebral Body Tethering vs. Thoracic Posterior Spinal Fusion
Vertebral Body Tethering (VBT) is a procedure which has garnered a lot of attention from surgeons, patients and families. Below is a list of talking points which should be known about VBT so there can be informative, educated, transparent discussions about VBT, when compared to the other commonly-performed procedure Posterior Spinal Fusions. Discussions on these […]
Pain Control and Muscle Spasm Management after Idiopathic Scoliosis Surgery
1. Preoperatively At At the last outpatient clinic visit before surgery, all patients will also have a visit with the Pediatric Anesthesia service on the same day. This group of physicians and Advanced Practice Providers (AAPs) will provide the general anesthesia (means the patient will be asleep) for the entire surgical procedure AND […]
“How much correction of the scoliosis did you get during surgery?” Part 2
In the last blog post I presented the position that 100% correction of the three-dimensional spinal deformity is NOT needed for optimal painless, long-term function. However, to create the ideal aesthetic or cosmetic appearance of the body, from shoulders to the hips, achieving >90% correction is probably what is needed to completely normalize the body […]
“How much correction of the scoliosis did you get during surgery ?”
6 months ago in the April 5th, 2021 blog post I addressed the question I sometimes get asked after surgery by parents, families and caregivers: “How much correction of the scoliosis did you get during surgery?” This blog post I will try to explain why we don’t always want 100%, or even 90% or 80% […]
Another new study on Vertebral Body Tethering (VBT)
This study comes from the San Diego group, who have a long, cautious experience with VBT. 23 patients whose mean age at surgery was 12.2 +/- 1.6 years Preoperatively: Mean curve 53 +/- 8 degrees All were Risser 0-1, Sanders 2-3 at surgery Minimum follow-up after surgery of 2 years, with mean follow-up of 3.4 […]
A nice piece on Shriners Hospital in St. Louis
https://www.kmov.com/news/im-one-of-the-luckiest-people-alive-doctor-finds-life-calling-at-shriners-hospitals-for/article_ec1147d2-1d82-11ec-b6d5-0b68d0a10fe8.html
Bertolotti’s Syndrome
What is Bertolotti’s Syndrome? Bertolotti’s Syndrome involves the lowest vertebra in the back; the one just above the sacrum, called the L5 vertebra. Basically, Bertolotti’s Syndrome is an abnormal development of the L5 vertebra, which occurred in utero. Normally the L5 vertebra is completely mobile (with a normal disc) and whose transverse processes do NOT […]
Blog Post on the latest, hot-off-the-presses publication on Vertebral Body Tethering
Some important points of this paper: 1. 1. Surgeries done 2011-2015, prior to FDA approval 2. 2. FDA primarily interested in device safety, secondarily on efficacy 3. 3. Inclusion criteria: a. Only include Type 1A and 1B curve patterns, which means only main thoracic curves. b. There were NO curve patterns with structural […]
High-Grade Spondylolisthesis (Part 5)
This is Part 5 on Spondylolistheses and we have gone from the mild deformities and progressing to the severe grades. In this post we will present a Type 5 High Grade deformity. This means the patient is compensating for the spondylolisthesis slippage, by rolling the pelvis backwards. In the Type 5 deformities it means the […]
High-Grade Spondylolisthesis (Part 4)
The several posts were on Low-Grade Slip/Spondylolisthesis Fusion Surgery, which are done for Grade 1 and 2 severity slips. We will now move onto High-Grade Slip/Spondylolisthesis Fusion Surgery…..which if you recall are for Grade 3-5 severity slips One of the best publications on the treatment of High-Grade Spondylolistheses is shown in the below two figures: […]
Low-Grade Spondylolisthesis (Part 3)
The case in the last post is a Low-Grade Slip/Spondylolisthesis Fusion Surgery. The cage which is placed in the front add to the strength of the repair, by minimizing deflection due to cantilever forces. The below link explain this: https://en.wikipedia.org/wiki/Deflection_(engineering) However, sometimes a cage isn’t needed or simply cannot be placed into the front of […]
Low-Grade Spondylolisthesis (Part 2)
To restate, a Low-Grade Spondylolisthesis is one which is a Meyerding Grade 1 or 2. This means the vertebra has slipped forward up to 50% of the vertebral body. To use a football analogy it hasn’t crossed the 50-yard line. Below is a Grade 2. We typically call spondylolistheses “slips”. What is the most […]
Spondylolisthesis (Part 1)
The last 6 posts have been discussing spondylolysis or pars fractures, which is crack in the posterior part of the spine which causes low back pain. If the vertebra slides forward (see below diagram), it is no longer spondylolysis, it is now called “spondylolisthesis” which means “vertebral slippage”. There are 6 types of spondylolistheses, […]
Spondylolysis/Pars Fracture: Surgical Treatment Part 6
The last blog post demonstrated my preferred method to fix spondylolysis/pars fractures, when nonsurgical methods fail to adequately relieve low back pain. There have been other method to stabilize the surgery as demonstrated below: The below case demonstrates why I prefer pedicle screw fixation-rod-laminar hook fixation: At this point he was 1 year out from […]
Spondylolysis/Pars Fracture: Surgical Treatment Part 5
If the nonsurgical treatment discussed over the last 2 posts fails to adequately relieve the low back pain due to spondylolysis/pars fractures, then surgery might be indicated. It is important to note that not all patients have the same pain intensity, frequency or interference with activities. The radiographs of the spondylolysis/pars fracture may look identical […]
Spondylolysis/Pars Fracture: Surgical Treatment Part 4
Frequently-Asked Questions: When should surgery be performed for spondylolysis/pars fractures? There is no one answer for everyone, as every situation is unique. Since nonsurgical management (mentioned in last blog post) may effective in minimizing or eliminating pain, it is necessary to see if this method is successful before undergoing surgery. If I have been […]
Spondylolysis/Pars Fracture: Nonsurgical Treatment Part 3
So far we have described the anatomy of the vertebra, the location of a pars fracture/spondylolysis, how it develops, and how we can diagnose it. Now we will discuss how to treat a pars fracture/spondylolysis. As mentioned in an earlier post the main symptom is low back pain, which typically increases with sporting/athletic activities, and […]
Spondylolysis or Pars Fracture
To summarize the previous post, the pars interarticularis likely never developed normally for individuals who get a spondylolysis or pars fracture. With continued stress on this area during normal and athletic activities the abnormally-developed pars cannot handle the repetitive stresses applied and a crack develops. If the pars is bone, why doesn’t it just heal […]
Spondylolysis or Pars Fracture
Before we talk about what is Spondylolysis or Pars Fracture, we need to understand what is normal. So, what is normal vertebral anatomy? As you below in the two drawings the vertebra of 3 parts: the vertebral body (which is in the front), the posterior elements (in the back; red circles), and the pedicles […]
Sports after Posterior Spinal Fusion T2-L2, 1 year postoperative
ApiFix MID-C
Non-fusion technologies for the treatment of scoliosis in the growing patient, has garnered increasing interest from patients and surgeons over the last 10 years. The advantages have been touted as being a minimally invasive procedure, rapid postoperative recovery, faster resumption of normal activities, less postoperative pain and preservation of more spine motion, when compared to […]
What is the Sanders Maturity Scale for bone age?
In the last blog post we discussed the Risser sign, a classic method to estimate bone age to predict the amount spinal growth remaining in adolescents with scoliosis. As you see from the last diagram in that post, the Risser sign doesn’t show up until AFTER the peak height velocity. So why does this matter? […]
What is Bone Age? Why does it matter for treatment of scoliosis?
What is bone age? Bone age is a method to determine the skeletal maturation level of a growing person. The younger the bone age, the more growth is ahead of them. Why not just use someone’s chronologic age? The chronologic age of a growing individual, which is calculated from their birth date to now, does […]
Idiopathic Scoliosis – Lumbar (5CN Curve Pattern)
14 year old female with progressive, painful thoracolumbar curve Highly athletic, three sport athlete. She has tried physical therapy for 3 months but has not helped decrease the intensity or frequency of her back pain. Participating in her sports is becoming difficult and is having back pain which is interfering with normal activities she does […]
Idiopathic Scoliosis
Below is a 16 year old female with idiopathic scoliosis, who is otherwise healthy. She noticed gradual development of waist asymmetry and a right rib prominence in the back. She was have daily back pain with athletics and having pain while in school. The below radiographs/x-rays demonstrate she has a 71 degree right thoracic curve […]
Congenital Spine Dislocation
Congenital dislocation of the spine (CDS) is a rare congenital malformation due to failure of the spine and the spinal cord to develop at a single spinal level. The patient may be completely neurologically intact or, in severe cases, may not have any muscle function or sensation below the level of the dislocation. It is […]
Vertebral Column Resection (VCR) in Pediatric Spinal Deformity Part 3
The last two blog posts were about the concept of VCR and the initial steps which are done, just before a VCR is performed. This post will talk about how a VCR is actually completed. How is a Vertebral Column Resection Performed? After the incision, spinal exposure and placement of pedicle screws the next important […]
Vertebral Column Resection (VCR) in Pediatric Spinal Deformity Part 2
How is a Vertebral Column Resection Performed? A vertebral column resection is performed under general anesthesia, which means the patient is asleep or unconscious, on a breathing machine (ventilator) and is face-down on the operating room table. Her Here is one of our spine nurses demonstrating how someone is positioned in the […]
Vertebral Column Resection (VCR) in Pediatric Spinal Deformity
What is a Vertebral Column Resection (VCR)? A VCR is complete surgical removal of one, or more, vertebra. It is always combined with posterior spinal fusion and instrumentation. This means screws, rods, and possibly cages are used to hold the spine in the new alignment while the spine undergoes bony fusion. Example C below. A […]
Utility of Preoperative Labs in Posterior Spinal Fusions for Idiopathic Scoliosis
https://rdcu.be/cizNe
How much correction of the scoliosis did you get during surgery?
This is a common question asked after spinal deformity surgery. Parents and caregivers are interested in how close their child’s spine was able to be returned to a “normal” alignment on x-ray. It is a very reasonable question. I would probably ask a similar question if my child was having scoliosis surgery. As a parent, […]
Surgeon Recommendations After Surgery
Sometimes our precious patients listen to us and other times…………………………………………not so much.
Severe, complex congenital scoliosis cases using Shilla procedures
Over the last 6 Blog posts congenital scoliosis has been exhaustively presented and explained. Most cases of congenital scoliosis are mild and do not require surgery. Of those that do need surgery there are several well-accepted techniques for improvement and control of the scoliosis: distraction constructs (traditional growing rods, magnetically-controlled growing rods, VEPTR), resection with […]
Surgical Treatment of Congenital Scoliosis
As previously mentioned congenital scoliosis comes in a wide range of types, locations, and complexity. This means surgeons caring for this group of patients needs to have multiple surgical treatment options to optimally care for this potentially challenging deformities, from simple hemivertebra resections to complex vertebral column resections and Shilla constructs. The below three cases […]
Surgical Treatment of Congenital Scoliosis
When is surgery necessary? This is not a simple answer, mainly because there is a wide spectrum of deformities, from number of areas involved, type of problems, location, magnitude, progression, and age of patient, to name a few of the considerations. Each patient is unique, so the decision of when surgery is a reasonable […]
Congenital Scoliosis #4
1. How much will the congenital scoliosis change with growth? a. Plain radiographs and MRI may be able to predict spinal growth and the chance of developing a spinal deformity or its speed of progression (worsening) in some patients. This is more likely if there is a single area of abnormal vertebral development. If […]
Congenital Scoliosis #3
Why is congenital scoliosis different than idiopathic, syndromic, neuromuscular? As presented 2 blogs ago, congenital scoliosis is the group of spinal deformity in children that is due to the vertebra being abnormally developed. The other three diagnostic categories usually have normal vertebra development, for the most part. So, in the other three the growth of […]
Congenital Scoliosis #2
Frequently-Asked Questions about congenital scoliosis 1. Why does it happen? Unfortunately we don’t know 2. When does it happen? In utero when the fetus is very, very small and is very early in its development. 3. What other problems can be associated with congenital scoliosis? There are three other organ systems which have high abnormality […]