Year: 2022
Growing Rod Constructs for Patients with Neuromuscular Scoliosis
This talk was presented at the International Pediatric Orthopaedic Symposium in Orlando, Florida last November 2022. My topic was to talk on patients with neuromuscular scoliosis (NMS) who were less than 8 years of age, presenting the argument to do Growing Rod (GR) surgeries, instead of performing a Posterior Spinal Fusion (PSF). My opponent was […]
Talking Points about Thoracic Vertebral Body Tethering vs. ApiFix
Vertebral Body Tethering (VBT) and the ApiFix device are procedures which have garnered a lot of attention from surgeons, patients and families. Below is a list of talking points which should be known about VBT and ApiFix so there can be informative, educated, transparent discussions about VBT and ApiFix, when compared to the other commonly-performed […]
Use of Magnetically-Controlled (MAGEC) Growing Rods in Neuromuscular Scoliosis
In past blog posts we have presented Magnetically-Controlled (MAGEC) Growing Rods. 1) There was the three-part series on the following dates: 3-9-2017 MAGEC: Part 1 5-3-2017 MAGEC: Part 2 5-18-2017 MAGEC: Part 3 2) On 11-28-2021 a study on the use of MAGEC vs. Posterior Spinal Fusion vs. Vertebral Body Tethering in 8-11 year […]
Posterior Spinal Fusion for Thoracic Scheuermann’s Kyphosis
Two blog posts ago the topic of thoracic Scheuermann’s Kyphosis (SK) was presented, stopping short of discussing the surgical treatment. In this post we will show a patient who underwent correction of his SK using posterior column osteotomies (see blog post from 9-6-2020) and posterior spinal fusion (see blog post from 1-16-2022). The two […]
Published study in Journal of Bone and Joint Surgery: Trunk Motion of Vertebral Body Tethering vs. Posterior Spinal Fusion
This was a study of trunk (back) motion from the Philadelphia Shriners hospital by a previous spine fellow from Washington University, Dr. Joshua Pahys. This elegant study used a motion analysis lab to quantify back motion between two groups of patients: 1) 65 patients having undergone Vertebral Body Tethering (VBT), and 2) 47 patients who […]
Thoracic Scheuermann’s Kyphosis
What is thoracic kyphosis? From the side the human spine is wavy, unlike the view from the front in which it should be straight. The only part of the spine with kyphosis is the thoracic spine, the cervical and lumbar spine are in lordosis. How much thoracic kyphosis is normal? In general normal kyphosis is […]
Talking Points for Early-Onset Scoliosis Patients: Magnetically-Controlled Growing Rods vs. Shilla Growth-Guidance
In the surgical treatment of Early-Onset Scoliosis (EOS) the options boil down to two main constructs: Distraction-Based: this encompasses both Traditional Growing Rods (TGR) and Magnetically-Controlled Growing Rods (MCGR) Growth-Guidance: this is also called the “Shilla Procedure” We will not go into detail about these two spine constructs, but ask you go […]
Blood Management During Spine Deformity Surgery
In 2022, spine deformity surgery usually requires a long incision and temporary retraction of muscles from the spine. This extensive exposure of the spine helps to loosen up the spine (to get better correction), insert pedicle screws to grip the spine and place the long rods, which moves the spine in space and maintains the […]
The Use of Internal Distraction in Severe Scoliosis
In severe scoliosis, the use of traction has demonstrated an ability to improve the spinal deformity before surgery was actually performed. There are three main methods: 1. Preoperative halo-gravity traction 2. Intraoperative halo-femoral traction 3. Intraoperative Internal Dis-Traction This post will focus on #3: Intraoperative Internal Dis-Traction To demonstrate this treatment we […]
Spinal Deformity in Neurofibromatosis Type 1 – Case #2
Surgical Case #2 The next case is a 14 year old male with NF-1. There are dystrophic changes to the spine around the thoracolumbar junction, specifically penciling of the ribs and scalloping of the vertebral bodies (red arrows). This has induced a painful kyphoscoliosis. The next pictures demonstrate there is some, but not much flexibility […]
Spinal Deformity in Neurofibromatosis Type 1 – Case #1
Surgical Case The case presented is a 13 year old male with NF-1 who has a severe, progressive, painful kyphoscoliosis. There is some inherent spinal flexibility as the thoracic kyphosis of 91 degrees improves when he lays on his back and hyperextends. The below selected MRI cuts demonstrates he does not have significant dural ectasias […]
Spinal Deformity in Neurofibromatosis Type 1
For details on Neurofibromatosis Type 1 (NF-1), I will refer you to Wikipedia: https://en.wikipedia.org/wiki/Neurofibromatosis_type_I As this blog focuses on spinal deformity in children and adolescents following is a brief summary as it relates to the musculoskeletal system (spine and extremities): 1. NF-1 causes tumors along nervous system which can grow anywhere on the body. […]
Recent Publication in The Spine Journal
Congenital Spine Dislocation with 8 Years of Postoperative Follow-up
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 […]
Disc herniation/Bulges in adolescents and how to treat
So, the symptoms of lumbar disc problems and the cause symptoms (pressure against nerve roots) are similar between adults and adolescents. What is different? In adults the pressure is created by a dehydrated (lack of water) or a bad disc herniates through the posterior ligament in adults In adolescents the growth plate on the vertebral […]
Disc herniation/Bulges in adolescents, and how they differ than those in adults
When talking about a new topic, I have tended to go into significant detail about the basics of the problem to be discussed. However, after review of the below webpage from the American Academy of Orthopaedic Surgeons (AAOS) I don’t think I can do a better, more thorough explanation of the anatomy, pathology, diagnosis and […]
Bone Grafting in Spine Surgery
In the previous blog post, we presented “what is a spine fusion”? In most pediatric spine surgeries metal implants correct and stabilize the spine in a new position (see below), then a spine fusion is performed. What I tell families/patients: “The metal allows us to attain and maintain the spine in a new position while […]
Latest Publication on Intraoperative Halo-Femoral Traction
Appointments: 314-514-3500 Appointments: 314-432-3600 This study was just published in the Journal of Spine Deformity For those interested to read more please use this hyperlink supplied by the publisher: https://rdcu.be/cFHmd
What is a “Spine Fusion”
In the average, normal spine there are 7 cervical, 12 thoracic, and 5 lumbar vertebra, a sacrum and coccyx. From the skull to the sacrum, each vertebra is separated by a mobile disc, which is a highly complex structure which provides stability and motion at the same time. In spinal deformity, such as scoliosis, the […]
What is ApiFix?
In previous posts the Anterior Vertebral Body Tethering (VBT) has been presented. This implant utilizes the flexibility of the growing thoracic spine, and its growth, to straighten the spine and then modulates its growth through the remainder of spinal growth. There has been a lot of social media interest and publications about this procedure over […]