ORCID Profile
0000-0003-3049-6345
Current Organisation
Nemours Children's Clinic
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Publisher: Springer Science and Business Media LLC
Date: 11-2022
Publisher: Informa UK Limited
Date: 11-2014
DOI: 10.2147/MDER.S73079
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 15-11-2022
DOI: 10.1097/BPO.0000000000002292
Abstract: Children with cerebral palsy (CP) frequently develop both neuromuscular hip dysplasia and scoliosis, and occasionally, the timing of the worsening of both of these pathologies is concurrent. The question as to whether the hip or spine should be addressed first in CP remains controversial, with the majority of evidence being “expert opinion.” The purpose of this project was to determine the impact of posterior spinal fusion (PSF) on the change in hip displacement for children with CP without previous reconstructive hip surgery. This was an Institutional Review Board-approved study that observed 67 patients from 2004 to 2018. Inclusion criteria included children with CP, 18 years of age and younger, Gross Motor Function Classification System IV and V, undergoing PSF at a single tertiary care children’s hospital with a minimum 2-year follow-up. The primary outcome was the change in hip displacement as quantified by the migration percentage (MP). The hip with the highest MP (worst hip) at the spine preoperative analysis were included for analysis. Triradiate cartilage (TRC) status and pelvic obliquity correction were analyzed with multivariate analysis. Sixty-seven patients were included for analysis, with a mean age of 12.5±2.3 years. The mean major curve angle of the major curve was 77±23 degrees and the mean preoperative pelvic obliquity was 21±12 degrees. There was no statistically significant change in MP after PSF from a mean preoperative value of 41±27%, to a mean postoperative value of 41±29% at the last follow-up, ( P =0.76) The mean follow-up time was 4.1±2.7 years. TRC status ( P =0.52) and the severity of pelvic obliquity ( P =0.10) did not statistically impact the change in MP after PSF. PSF did not influence—either negatively or positively—the progression of hip displacement in children with CP, regardless of pelvic obliquity correction or TRC status. The lack of deterioration in hip displacement post-PSF, however, may suggest a protective effect of spine surgery. Level III—retrospective cohort study.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 06-2022
DOI: 10.1097/BPO.0000000000002173
Abstract: Radiographic lucency around a smooth pelvic rod (Galveston/unit rod technique) or sacroiliac/iliac screw following spinal fusion in children with nonambulatory spastic cerebral palsy (CP) has been described as a “windshield wiper” phenomenon. We evaluated demographics, radiographs, and complications in 101 cases from a single center to determine prevalence, risk factors, and complications associated with persistent radiographic lucency from 1 to 5 years following spinal fusion. Inclusion criteria were diagnosis of nonambulatory spastic quadriplegic CP [Gross Motor Function Classification System (GMFCS) IV-V], under 18 years of age, scoliosis treated by posterior fusion from upper thoracic to sacrum with pelvic fixation (Galveston rod, iliac screw, or sacroiliac screw), adequate radiographs (preoperative, immediate postoperative, first-year, and second-year), and minimum 5-year follow-up. We evaluated demographics, radiographic parameters, comorbidities, scoliosis curve type, type of pelvic screw/rod, use of off-set connector, screw width, associated with posterior column osteotomy and/or additional anterior spinal release concurrent with posterior spine fusion, and infection over the follow-up period. Specific attention was given to the area and shape of the radiographic lucency. The logistic regression analysis was performed for continuous and categorical variables to define risk factors ( P =0.05). In 101 patients, data were collected at mean intervals of 1-year, 2-year, and -year follow-up and were 12.9±1.5, 25.8±2.5, and 81.5±23.0 months, respectively. Prevalence of pelvic rod/screw radiographic lucency was unchanged at 33%, 35%, and 24% at 1-year, 2-year, and -year follow-up, respectively, and radiographic parameters did not change ( P .05). Furthermore, no risk factors or complications were associated with radiographic lucency around pelvic rods/screws ( P .05). In patients with spastic nonambulatory CP who had scoliosis treated with posterior spinal fusion from upper thorax to pelvis, the prevalence of pelvic rod/screw lucency is high. Persistent lucency mm around pelvic implants is not clinically significant, does not warrant advanced imaging, or indicate a complication if stable over time and wider distally than proximally. Level III.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2016
DOI: 10.1097/BPB.0000000000000241
Abstract: Flexion-type supracondylar fractures are challenging to treat because, unlike extension-type fractures, it is difficult to take advantage of the intact periosteal hinge to stabilize the fracture fragments during percutaneous pinning. Some authors have described closed reduction of these fractures with the elbow in extension, followed by percutaneous K-wire fixation. However, percutaneous pinning with elbow in extension is technically difficult, time consuming, and usually requires the help of a skilled assistant because of persistent fracture instability. To circumvent these difficulties, we utilized a ‘push–pull’ maneuver, which simplifies the closed reduction and fixation of these difficult fractures. We describe the surgical technique for the ‘push–pull’ method and report radiographic outcomes of a case series of children with flexion-type supracondylar fractures treated using this technique. A retrospective review of medical records and radiographs of all children who underwent operative treatment of a flexion-type supracondylar humeral fracture using the ‘push–pull’ method in a tertiary-level children’s hospital between January 2009 and January 2014 was carried out. Radiographic outcomes were reported using descriptive statistics. There were a total of nine patients (five females, four males), average age 9.8 years (4–14 years). Seventy-eight percent (7/9 patients) of the children had type III injuries, whereas 22% (two children) had type II injuries. The average duration of surgery was 41 min (24–60 min). No intraoperative or postoperative complications were recorded. Postoperative radiographic measures showed that the anterior humeral line passed through the middle third of capitellum in 78% of patients (7/9 patients), whereas it passed posterior to it in 22% (two patients). The average humerocapitellar angle was 30° (21–44°) and the anterior coronoid line was unbroken in 44% (4/9 patients). The average humeroulnar angle was 13° (8–20°) of valgus. The ‘push–pull’ is a safe, effective, and easy method to treat unstable flexion-type supracondylar fractures in children with good radiographic postoperative outcomes. Level of evidence: level IV.
Publisher: Wiley
Date: 26-03-2022
DOI: 10.1111/DMCN.15228
Abstract: To determine how surgical burden and preoperative factors affect the recovery of walking activity after multilevel orthopedic surgery (MLS). In this retrospective study, inclusion criteria were a diagnosis of cerebral palsy, MLS, and walking activity monitoring using a StepWatch device within 12 months pre‐MLS and 24 months post‐MLS. The outcome measure was total mean strides per day normalized to age and Gross Motor Function Classification System level. Pre‐ and postoperative walking activity were compared using unpaired t‐ tests the effects of preoperative predictors and surgical burden on the recovery of walking activity were evaluated using regression analysis. Participants included 178 children (mean age 12 years 10 months [SD 8 years 7 months range 4–20 years] 91 males, 87 females). On average, children returned to baseline walking activity 3 months after low‐burden surgery and 1 year 2 months after high‐burden surgery. Postoperative walking activity was higher for children who had surgery at a younger age and those with a higher preoperative mobility function. The burden of MLS was found to be inversely related to the time to recovery of postoperative walking activity. These findings provide evidence to help clinicians set expectations for return to function post‐MLS. Further study is necessary to investigate the impact of postoperative factors on walking activity recovery. High‐burden surgeries lead to longer recovery than low‐burden surgeries. Younger children recover walking activity faster after multilevel orthopedic surgery. Children with high preoperative mobility function recover walking activity faster after surgery.
Publisher: Elsevier BV
Date: 10-2021
DOI: 10.1016/J.GAITPOST.2021.08.022
Abstract: The longitudinal stability of sagittal gait patterns in diplegic cerebral palsy (CP), stratified using the Rodda classification, is currently unknown. What is the trajectory of sagittal plane gait deformities as defined by the Rodda classification in a large cohort treated with orthopedic surgery guided by gait analysis? A retrospective study utilized gait analysis to evaluate sagittal gait parameters before age 8 and after age 15 years. In idual limbs were categorized at each time point according to the Rodda classification based on mean sagittal plane knee and ankle angle during stance. Welch's t-tests compared gait variables from early childhood with maturity and examined changes associated with plantarflexor lengthening surgery. 100 youth with CP were evaluated twice: at a mean age of 5.49 ± 1.18 and 19.09 ± 4.32 years, respectively. Gross Motor Function Classification System distribution at maturity was I (10.5 %), II (55.2 %), III (28.6 %), and IV (5.7 %). At the initial visit, most limbs were in either true equinus (30 %) or jump-knee gait (26.5 %). At maturity, crouch gait (52.5 %) was the most common classification, of which 47.6 % were mild (1-3 standard deviations from age-matched norm 21°-30°) and 52.4 % moderate or severe. For the entire cohort, at initial and final visits, respectively, mean knee flexion in stance was 26.8°±14.8° and 25.9°±11.4° (p = 0.320), ankle dorsiflexion in stance increased from -0.3°±11.5° to 9.0°±6.0° (p 0.18). The trend in this cohort was toward crouch with increased stance phase ankle dorsiflexion from early childhood to maturity. Plantarflexor lengthenings were not a significant factor in the progression of stance phase knee flexion.
Publisher: Wiley
Date: 19-10-2016
DOI: 10.1002/RCS.1781
Abstract: Open posterior spinal procedures involve extensive soft tissue disruption, increased hospital length of stay, and disfiguring scars. Our aim was to demonstrate the feasibility of using robotic-assistance for minimally invasive exposure of the posterolateral spine with and without carbon dioxide (CO Sheep specimens underwent minimally invasive subperiosteal dissection of the spine during three trials. The da Vinci S Surgical system was used for access with and without working space support via CO Without insufflation, a sub-paraspinal muscle tunnel measuring 16 cm was developed between two 5 cm incisions. With insufflation, the one-sided tunnel length was 12.5 cm but without the soft tissue trauma and obstructed visualization experienced without CO The use of robot-assistance for minimally invasive access to the posterior spine appears to be feasible. The use of CO
Publisher: SAGE Publications
Date: 02-12-2012
Abstract: The incidence of spinal injuries is increased in people with epilepsy although compressive thoracic myelopathy has not been reported. We describe a 15-year-old girl with SCN1A mutation (Dravet syndrome), refractory generalized tonic-clonic seizures, and prior posterior instrumentation and fusion for scoliosis, who presented with progressive lower extremity weakness. Junctional kyphosis with disc herniation and spinal cord compression directly rostral to the instrumentation was apparent on imaging. On history, the patient had suffered a particularly severe convulsive seizure just before developing symptoms. Surgical decompression and stabilization led to a complete neurologic recovery. This unusual presentation of myelopathy illustrates the need to consider this complication in patients with epilepsy and spinal instrumentation.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 13-05-2021
DOI: 10.1097/BPO.0000000000001845
Abstract: Transverse myelitis (TM) is a rare inflammatory disorder of the spinal cord. It can have a heterogeneous presentation with sensory, motor, and autonomic dysfunction. Neurological sequelae of TM include autonomic dysfunction, motor weakness, and/or spasticity. Studies describing orthopaedic deformities and treatments associated with TM are nonexistent. This purpose of this study was to describe the orthopaedic manifestations of TM in children. A multicenter retrospective review was conducted of patients, 0 to 21 years of age, with TM presenting over a 15-year period at 4 academic children’s hospitals. Those with confirmed diagnosis of TM and referred to an orthopaedic surgeon were included. Demographics, orthopaedic manifestations, operative/nonoperative treatments, and complications were recorded. Descriptive statistics were used for data reporting. Of 119 patients identified with TM, 37 saw an orthopaedic surgeon. By etiology, 23 were idiopathic (62%), 10 infectious (27%), 3 (8%) inflammatory/autoimmune, and 1 (3%) vascular. The mean age at diagnosis was 6.7 (SD: 5.5) years and at orthopaedic presentation was 8.4 (SD: 5.2) years. Orthopaedic manifestations included scoliosis in 13 (35%), gait abnormalities in 7 (19%), foot deformities in 7 (19%), upper extremity issues in 7 (19%), symptomatic spasticity in 6 (16%), lower extremity muscle contractures in 6 (16%), fractures in 6 (16%), hip displacement in 3 (8%), pain in 2 (5%), and limb length discrepancy in 2 (5%) patients. Seven children (19%) were seen for establishment of care. In all, 14 (38%) underwent operative intervention, mainly for soft-tissue and scoliosis management. Four patients had baclofen pump placement for spasticity management. Postoperative complications occurred in 36% of cases, most commonly because of infection. Neither topographic pattern nor location of lesion had a significant relationship with need for hip or spine surgery. This report describes the orthopaedic manifestations associated with TM in children, nearly 40% of whom required operative intervention(s). Understanding the breadth of musculoskeletal burden incurred in TM can help develop surveillance programs to identify and treat these deformities in a timely manner. Level IV
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2004
DOI: 10.1097/01.BRS.0000148248.78535.94
Abstract: Case report. To report a rare traumatic C1-C2 dislocation associated with fracture of the anterior arch of the atlas in a neurologically intact patient. Isolated fractures of the anterior arch of C1 are very rare. There have been reports of horizontal fractures of the anterior arch thought to occur secondary to hyperextension injuries with subsequent avulsion of the anterior tubercle of the atlas. To our knowledge, however, there are no previously reported cases of isolated anterior arch fractures of C1 associated with posterolateral dislocation of the C1-C2 articulation. A 53-year-old patient who presented with a posterolateral dislocation of the C1-C2 articulation and an associated anterior arch fracture of C1 is reported. Details of the initial presentation, diagnostic strategy, and initial and definitive management are provided. Closed reduction with halo ring application and gentle manipulation was followed with definitive internal fixation consisting of Magerl C1-C2 transarticular screw fixation coupled with modified Brooks fusion. Posterolateral C1-C2 dislocation associated with atlantal anterior arch fracture is a rare injury that can be effectively treated with gentle closed reduction under fluoroscopic guidance followed by internal fixation with or without halo vest immobilization. Recognition of associated conditions including vertebral artery compromise, concomitant cervical spine fractures, and life-threatening injuries is paramount to the successful treatment of these patients.
Publisher: Frontiers Media SA
Date: 20-09-2021
DOI: 10.3389/FNEUR.2021.732906
Abstract: Introduction: The transition from pediatric health care and school systems presents enormous challenges for young adults with cerebral palsy (CP). The lack of strong societal support during this seminal life event is well-documented and leads many adults with CP to struggle with independence, higher education, and employment. Despite the relatively high prevalence of CP, information about the experiences and function of adults with CP in our society continues to be limited. The purpose of this project was to describe well-being by assessing education, employment, physical function, walking activity, and utilization of health care in an ambulatory adult cohort with CP who received specialized pediatric care at our center. Method: In this Institutional Review Board-approved prospective study, we invited former patients from our tertiary care pediatric CP center to complete a set of patient-reported outcomes including (1) the Patient-Reported Outcomes Measurement Information System domains of physical function and pain interference, (2) the Satisfaction with Life Scale, and a project-specific demographic questionnaire about education, employment, income, independence, pain, and health care utilization. Participants also wore a pedometer for 8 days to monitor community walking activity. Chi-squared pairwise or t -tests were used as appropriate to compare survey responses and walking activity data between three groups: participants who self-reported, those who reported by proxy, and published normative data from age-matched typically developing adult (TDA) s les. Results: One hundred twenty-six adults with CP consented to participate 85 self-reported [age 29.7 ± 4.3 years Gross Motor Function Classification System: I (28%), II (47%), and III, (25%)] and 41 reported by proxy [age 29.7 ± 4.1 years Gross Motor Function Classification System: I (10%), II (68%), and III (22%)]. For the group who self-reported, high school graduation rate (99%) was similar to TDA (92% p = 0.0173) but bachelor's degree achievement rate (55%) was higher than TDA (37% p & 0.001). Despite more advanced education, the unemployment rate in this group was higher than national levels at 33% and was associated with high utilization of Social Security Disability Insurance (33%). Within the self-reporting group, 13% required a caregiver. For the group who reported by proxy, educational levels (73% high school graduates, 0 bachelor's degree) were lower than the general population ( p & 0.001) and unemployment was higher than the national level, at 64%. Unemployment in this group was associated with high utilization of Social Security Disability Insurance (85%). Within the proxy-reporting group, 71% required a caregiver. The full cohort demonstrated lower levels of physical function according to the Patient-Reported Outcomes Measurement Information System and less community walking activity compared with TDA references ( p & 0.001). This cohort of adults with CP reported significantly higher frequency of chronic pain (48 vs. 12% for TDA p & 0.001), but less pain interference with daily activities than TDA based on Patient-Reported Outcomes Measurement Information System results ( p & 0.001). This cohort reported good to excellent overall health (93%) and high utilization of primary care (98%), but limited utilization of specialty care, specifically orthopedic care (21%) and physical therapy (15%). Discussion: This cohort of adults with CP had similar levels of education as the general population, but had relatively high rates of unemployment, caretaker need, and Social Security Disability Insurance utilization. Although chronic pain was frequent, the impact of pain on work and independent living did not exceed reports from a typically developing reference. Better targeted societal resources for adults with physical disabilities are urgently needed to allow equitable access to employment, promote opportunities for independence, and enable full participation in community life.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 09-2019
Publisher: Springer Science and Business Media LLC
Date: 24-07-2013
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 15-03-2017
Publisher: Wiley
Date: 17-12-2013
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 11-11-2021
DOI: 10.1097/BPO.0000000000002000
Abstract: The purpose of this study was to utilize a multicenter, multisurgeon cohort to assess the effect of surgeon experience on outcomes of growth friendly instrumentation (GFI) in early onset scoliosis (EOS). We hypothesized that unplanned return to the operating room (UPROR), estimated blood loss (EBL), and surgical time would be greater amongst early career surgeons (ECSs) when compared with advanced career surgeons (ACSs). An international pediatric spine database was queried for patients ages 2 to 10 years treated by posterior distraction-based GFI with at least of 2-year follow up. Two groups were created for analysis based on surgeon experience: ECSs (with ≤10 y of experience) and ACSs (with y of experience). The primary outcome was UPROR. Additional outcomes included: operating room time, EBL, neurological deficits, infection rate, hardware failure, and the Early Onset Scoliosis Questionnaire (EOSQ-24). Subgroup analysis was performed for further assessment based on procedure type, superior anchor type, etiology, and curve severity. A total of 960 patients met inclusion criteria including 243 (25.3%) treated by ECS. Etiology, sex, superior anchor, and EOSQ-24 scores were similar between groups ( P .05). There were no clinically significant differences in patient age or preoperative major coronal curve. UPROR (35.8% vs. 32.7%, P =0.532), infection (17.0% vs. 15.6%, P =0.698), operating room time (235 vs. 231 min, P =0.755), and EBL (151 vs. 155 mL, P =0.833) were comparable between ECS and ACS groups. The frequency of having at least 1 complication was relatively high but comparable among groups (60.7% vs. 62.6%, P =0.709). EOSQ-24 subdomain scores were similar between groups at 2-year follow-up ( P .05). Subgroup analysis revealed that ECS had increased surgical time compared with ACS in severe curves degrees (270 vs. 229 min, P =0.05). This study represents the first multicenter assessment of surgeon experience on outcomes in EOS. Overall, surgeon experience did not significantly influence UPROR, complication rates, EBL, or surgical time associated with GFI in this cohort of EOS patients. Level III.
Publisher: Wiley
Date: 09-09-2022
DOI: 10.1111/DMCN.15018
Abstract: Until recently, there has been little interest in understanding the intrinsic features associated with the pathomorphology of skeletal muscle in cerebral palsy (CP). Coupled with emerging evidence that challenges the role of spasticity as a determinant of gross motor function and in the development of fixed muscle contractures, it has become increasingly important to further elucidate the underlying mechanisms responsible for muscle alterations in CP. This knowledge can help clinicians to understand and apply treatment modalities that take these aspects into account. Thus, the inherent heterogeneity of the CP phenotype allows for the potential of personalized medicine through the understanding of muscle pathomorphology on an in idual basis and tailoring treatment approaches accordingly. This review aims to summarize recent developments in the understanding of CP muscle and their relationship to musculoskeletal manifestations, in addition to proposing a treatment paradigm that incorporates this new knowledge.
Publisher: Springer Science and Business Media LLC
Date: 21-06-2019
Publisher: Springer Science and Business Media LLC
Date: 13-06-2022
DOI: 10.1007/S43390-022-00532-6
Abstract: Given reduced rates of both pulmonary function decline and scoliosis progression with steroid treatment in Duchenne muscular dystrophy (DMD), the role of early scoliosis surgery has been questioned. The purpose of this study was to compare the postoperative complication rates of early versus late scoliosis correction in DMD. This study was a retrospective cohort, conducted at an academic tertiary level children's hospital. Patients with DMD who underwent posterior scoliosis correction, with preoperative pulmonary function testing [forced vital capacity (FVC)] were included and ided into two groups by preoperative curve angles: ≤ 45° and > 45°. The primary outcome variable was postoperative complications by Clavien-Dindo classification grading. Secondary outcome variables included postoperative complications occurring after the first 90 days, age at surgery, duration of wheelchair dependency preoperatively, pulmonary function, steroid utilization, shortening fraction by echocardiogram, surgery duration, intensive care unit/hospital length of stay, days intubated, infection, and percent curve correction. Two-tailed t-test and Chi-square testing were used for analysis of patient factors and Clavien-Dindo complication grade, respectively. Thirty-one patients were included with a total follow-up of 8.3 ± 3.2 years, 4.8 ± 2.2 years post-spinal fusion. Steroid treatment (prednisone, deflazacort) was utilized for 21 (67.7%) patients. Primary curve correction was not different between groups (65.0% vs 71.4% [p = 0.37]). There were no significant differences in Clavien-Dindo classification grades between groups (p > 0.05). For the entire cohort, the overall complication rate was higher for patients with steroid treatment (61.9% vs 10.0% [p = 0.008]). Neither forced vital capacity nor fractional shortening on echocardiogram was different between groups at final follow-up (p = 0.6 and p = 0.4, respectively). The comparable risk of perioperative complications for early and late scoliosis correction supports a "watchful waiting" approach, whereby curves less than 45° can be carefully followed while cardiopulmonary function is maintained. Patients undergoing steroid treatment should be counseled regarding the higher risk of postoperative blood transfusion and deep wound infection. III Retrospective cohort.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 22-12-2020
Publisher: Elsevier BV
Date: 04-2019
DOI: 10.1016/J.JBIOMECH.2019.02.023
Abstract: Cerebral palsy (CP) is the result of a static brain lesion which causes spasticity and muscle contracture. The source of the increased passive stiffness in patients is not understood and while whole muscle down to single muscle fibres have been investigated, the smallest functional unit of muscle (the sarcomere) has not been. Muscle biopsies (adductor longus and gracilis) from pediatric patients were obtained (CP n = 9 and control n = 2) and analyzed for mechanical stiffness, in-vivo sarcomere length and titin isoforms. Adductor longus muscle was the focus of this study and the results for sarcomere length showed a significant increase in length for CP (3.6 µm) compared to controls (2.6 µm). Passive stress at the same sarcomere length for CP compared to control was significantly lower in CP and the elastic modulus for the physiological range of muscle was lower in CP compared to control (98.2 kPa and 166.1 kPa, respectively). Our results show that CP muscle at its most reduced level (the myofibril) is more compliant compared to normal, which is completely opposite to what is observed at higher structural levels (single fibres, muscle fibre bundles and whole muscle). It is noteworthy that at the in vivo sarcomere length in CP, the passive forces are greater than normal, purely as a functional of these more compliant sarcomeres operating at long lengths. Titin isoforms were not different between CP and non-CP adductor longus but titin:nebulin was reduced in CP muscle, which may be due to titin loss or an over-expression of nebulin in CP muscles.
Publisher: Springer Science and Business Media LLC
Date: 21-06-2021
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2006
DOI: 10.2106/JBJS.E.00071
Publisher: Wiley
Date: 20-05-2023
DOI: 10.1111/DMCN.15641
Abstract: This letter to the editor is on the commentary by Gormley on pages 1003–1004 of this issue.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2022
Abstract: This is a case of a 7-year-old boy with a Lisfranc injury identified on weight-bearing films who was treated successfully with closed reduction with a cl and smooth pin fixation. This patient returned to sports without pain or radiographic signs of arthritis at 1 year. Lisfranc fractures and ligamentous injuries are rare and can occur in skeletally immature children. They have high potential for long-term disability if not properly diagnosed and treated. Although there is no consensus on optimal management of pediatric Lisfranc injuries, restoration of an anatomic Lisfranc joint with smooth pins and immobilization for 6 weeks is a viable treatment option.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 14-10-2022
DOI: 10.1097/BPO.0000000000002276
Abstract: Children with cerebral palsy (CP) at Gross Motor Function Classification System (GMFCS) levels III/IV are at risk for losses in standing function during adolescence and transition to adulthood. Multilevel surgery (MLS) is an effective treatment to improve gait, but its effects on standing function are not well documented. The objectives of our study were to describe standing function in children with CP classified as GMFCS levels III/IV and evaluate change after MLS. This retrospective study included children with CP (GMFCS III/IV) ages 6 to 20 years who underwent instrumented gait analysis. A subset who underwent MLS were evaluated for change. Primary outcome measures were Gross Motor Function Measure dimension D, gait velocity, functional mobility scale, and the Pediatric Outcomes Data Collection Instrument (PODCI). Additional impairment level measures included foot pressure, knee extension during stance phase of gait, and knee extension passive range of motion. Four hundred thirty-seven instrumented gait analysis sessions from 321 children with CP (ages 13.7±4.8 y GMFCS III-81%/IV-19%) were included. The GMFCS III group had higher Gross Motor Function Measure dimension D, gait velocity, PODCI scores, and better knee extension compared with the GMFCS IV group ( P .05) 94 MLS were evaluated for postoperative change 15.3±4.2 months after MLS. Children at GMFCS level III had improved PODCI scores ( P .05), better knee extension passive range of motion ( P .01), and improved coronal plane foot pressure ( P .05) post MLS. Maximum knee extension during stance and heel impulse improved significantly in both groups ( P .01). Standing function of children with CP at GMFCS IV was significantly more limited than at GMFCS III. After MLS, both groups (III/IV) showed improvement in impairment level outcomes (knee extension and foot position), whereas only those functioning at GMFCS III had improvement in activity articipation outcomes according to the PODCI. For children with CP at GMFCS levels IV, MLS may improve standing function, but appropriate goals related to assisted standing and measurement protocols sensitive to limited functional mobility should be adopted. Level III—retrospective comparative study.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 18-11-2022
Abstract: Recommendations with regard to the need for continued hip surveillance after skeletal maturity are based on expert opinion rather than evidence. This study aimed to determine the prevalence of and risk factors associated with progressive hip displacement in cerebral palsy (CP) after triradiate cartilage (TRC) closure. Patients who had spastic nonambulatory CP (Gross Motor Function Classification System IV to V) and hypertonic (spastic or mixed-type) motor type and follow-up of at least 2 years after TRC closure were included. The primary outcome variable was the hip migration percentage (MP). The secondary outcome variables included patient age at the time of TRC closure, prior preventative or reconstructive surgery, a prior intrathecal baclofen pump, history of scoliosis, history of epilepsy, a prior gastrostomy tube, a previous tracheostomy, and gender. An unsuccessful hip outcome was defined as a hip with an MP of ≥40% and/or requiring a reconstructive surgical procedure after TRC closure. In this study, 163 patients met the inclusion criteria, with a mean follow-up of 4.8 years (95% confidence interval [CI], 4.4 to 5.1 years) after TRC closure at a mean patient age of 14.0 years (95% CI, 13.7 to 14.3 years). Of these hips, 22.1% (36 of 163) had an unsuccessful hip outcome. In multivariate analysis, the first MP at TRC closure (hazard ratio [HR] per degree, 1.04 p 0.001) and pelvic obliquity (HR per degree, 1.06 p = 0.003) were independent risk factors for an unsuccessful hip outcome, but gender was not found to be significant (HR for male gender, 1.7 [95% CI, 0.8 to 3.58 p = 0.16] female gender was the reference). However, the mean survival time for progression to an unsuccessful hip outcome was longer for female patients at 9.2 years [95% CI, 8.1 to 10.2 years]) compared with 6.2 years (95% CI, 5.6 to 6.9 years) for male patients (p = 0.02). There was also a significant improvement in survivorship for prior reconstructive surgical procedures (p = 0.002). The survivorship in patients who underwent reconstructive surgery performed at a patient age of ≥6 years was significantly higher compared with those who underwent surgery performed at years of age (p 0.05). A first MP at TRC closure of ≥35% was associated with an unsuccessful hip outcome, as determined by receiver operating characteristic (ROC) curve analysis (p 0.001 area under the ROC curve of 0.891, sensitivity of 81%, and specificity of 94%). The risk factors for the progression of hip displacement after TRC closure in patients with CP included a higher MP and increased pelvic obliquity there was decreased survivorship for male patients and patients with no prior reconstructive surgery. Patients with these risk factors and/or an MP of ≥35% at TRC closure should have continued radiographic surveillance to detect late hip displacement. Prognostic Level III . See Instructions for Authors for a complete description of levels of evidence.
Publisher: Springer Science and Business Media LLC
Date: 10-02-2022
DOI: 10.1007/S43390-022-00477-W
Abstract: Operative and postoperative management of early onset scoliosis (EOS) patients with programmable implanted devices has not been well characterized in the literature. The aim of this study was to describe current practices for pediatric spine surgeons who operate on patients with these devices. An electronic survey was distributed to 167 pediatric spine surgeons between January and March of 2021. The survey queried participants on operative and postoperative management of patients with the following implanted devices: vagal nerve stimulators, ventriculoperitoneal shunts, intrathecal baclofen pumps, pacemakers, and cochlear implants. Descriptive statistics were used to assess survey data. Fifty-three respondents (31.7% response rate) with a mean 16.5 (SD 12.0) years in practice completed the survey. Depending on the type of device present, surgeons report changing their operative plan anywhere from 28.6 to 60.1% of the time when inserting magnetically controlled growing rods. Most respondents reported performing transcranial motor evoked potentials (80.0-98.0%) and monopolar cautery (70.0-92.9%) across implanted devices. Only 10% (n = 5) of surgeons reported complications related to operative and/or postoperative management of these patients. No complications were related to cautery, neuromonitoring, or surgical placement of MCGRs. This study demonstrates variation in operative and postoperative management of these patients with various programmable implanted devices. Much of this inconsistency in practice is likely due to decades old case reports, constantly changing device manufacturer recommendations, and/or published simulation studies. Reported heterogeneity in management across surgeons necessitates development of published guidelines regarding proper operative and postoperative management of patients with EOS and implanted devices.
Publisher: Elsevier BV
Date: 2019
DOI: 10.1016/J.MEHY.2018.11.002
Abstract: In cerebral palsy (CP), the spastic motor type is most common, associated with a velocity-dependent increase in muscle stiffness that precedes the development of fixed muscle contracture - a permanent shortening of the muscle tendon unit even when relaxed. Intra-muscular injections of botulinum toxin type A (BTX-A) have become popular for the treatment of spastic muscle contractures but unfortunately its use has not resulted in long-term functional benefits and, paradoxically, has been associated with a persistent loss of contractile material. Recent biomechanical work has shown that the stiffness of the CP muscle increases in proportion to total collagen content within the perimysial extra-cellular matrix. Thus, rather than the use of tone-reducing agents, we hypothesize that the focal use of a selective collagenase, injected into spastic muscle at an appropriate dilution and concentration, may serve to reduce the extent of muscle contracture, improving clinical range of motion and perhaps sarcomere length.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 08-2019
DOI: 10.2106/JBJS.RVW.18.00153
Abstract: » Sarcopenia is common in both the elderly and children with cerebral palsy. » Children with cerebral palsy have muscles that are much smaller than muscles in typically developing peers. » Injections of botulinum toxin type A (BoNT-A) result in acute muscle atrophy in animal models and in human subjects. » It is not known when or if muscles recover fully after injection of BoNT-A. » These findings have implications for management protocols.
Publisher: SAGE Publications
Date: 04-2022
DOI: 10.1177/18632521221084184
Abstract: The aim of this article was to compare longitudinal changes in hip morphology in cerebral palsy (hypertonic) and spinal muscular atrophy (hypotonic) to examine the influence of muscle tone on development of hip displacement. Children with spinal muscular atrophy (Types I and II) and cerebral palsy (Gross Motor Function Classification System IV and V) with hip displacement (migration percentage %) were included. Head shaft angle, migration percentage, and acetabular index were measured at T1 (1–2.5 years), T2 (3–5 years), and T3 (6–8 years). Analysis of variance testing and linear regression were utilized. Sixty patients (cerebral palsy, N = 41 spinal muscular atrophy, N = 19) were included. Hip displacement occurred earlier in spinal muscular atrophy (34 months) than cerebral palsy (49 months) (p = 0.003). Head shaft angle was high and did not change between T1, T2, and T3, but significant changes in migration percentage were found (cerebral palsy: 23%, 36%, 45% (p 0.01) and spinal muscular atrophy: 37%, 57%, 61% (p = 0.02)). Migration percentage increased by age in cerebral palsy (r = 0.41, p 0.001), but not in spinal muscular atrophy (r = 0.18, p = 0.09). Acetabular index increased with migration percentage (cerebral palsy: r = 0.41, p 0.001 spinal muscular atrophy: r = 0.48, p 0.001). Persistent lateral physeal tilt by head shaft angle was found for both spinal muscular atrophy and cerebral palsy. Abnormal physeal alignment may be causally related to weakness of the hip abductor muscles rather than spasticity or muscle imbalance, resulting in coxa valga and secondary acetabular dysplasia. III (case–control study).
Publisher: Springer Science and Business Media LLC
Date: 08-03-2021
DOI: 10.1007/S43390-021-00302-W
Abstract: Scoliosis often occurs coincident with pulmonary function deterioration in spinal muscular atrophy but a causal relationship has not yet been reliably established. A systematic literature review was performed, with pulmonary function testing being the primary outcome pre- and post-scoliosis surgery. Levels of evidence were determined and GRADE recommendations made. Ninety studies were identified with only 14 meeting inclusion criteria. Four studies were level III and the rest were level IV evidence. The average age at surgical intervention was 11.8 years (follow-up 6.1 years). Post-operative pulmonary function progressively declined for the majority of studies. Otherwise, pulmonary function: improved (two studies), were unchanged (two studies), had a decreased rate of decline (three studies), declined initially then returned to baseline (two studies). Respiratory and spine-based complications were common. Given the available evidence, the following GRADE C recommendations were made: (1) surgery is most often associated with decreases in pulmonary function (2) the impact of surgery on pulmonary function is variable, but does not improve over pre-operative baseline (3) surgery may result in a decreased rate of decline in pulmonary function post-operatively. Given this lack of evidence-based support, the risk–benefit balance should be taken into consideration when contemplating scoliosis surgery.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 20-10-2022
Abstract: The “law of diminishing returns” is described for traditional growing rods. Magnetically controlled growing rods (MCGRs) have become a preferred implant for the surgical treatment of early-onset scoliosis (EOS). We examined a large cohort of patients with EOS to determine whether the law of diminishing returns applies to MCGRs. A prospectively collected, multicenter registry was queried for patients with EOS treated with MCGRs. Patients with only spine-based implants and a minimum of 2 years of follow-up were included patients with congenital scoliosis, single rods, lengthenings, or % missing data were excluded. Patients were analyzed in 3 cohorts: primary MCGR (pMCGR) had first-time MCGR implants, secondary MCGR (sMCGR) were converted from an MCGR to a new MCGR, and conversion MCGR (cMCGR) were converted from a non-MCGR implant to MCGR. A total of 189 patients in the pMCGR group, 44 in the cMCGR group, and 41 in the sMCGR group were analyzed. From post-MCGR placement to the most recent follow-up or pre-definitive procedure, there were no differences in the changes in major Cobb angle, T1-S1 height, or T1-T12 height over time between the pMCGR and cMCGR groups. There was a decrease in length achieved at subsequent lengthenings in all cohorts (p 0.01), and the sMCGR group had a significantly poorer ability to lengthen at each subsequent lengthening versus the pMCGR and cMCGR groups (p 0.02). The 1-year survival rate was 90.5% for pMCGR, 84.1% for sMCGR, and 76.4% for cMCGR 2-year survival was 61.5%, 54.4%, and 41.4%, respectively and 3-year survival was 37.6%, 36.7%, and 26.9%, respectively. Excluding MCGRs still expanding, 27.6% of pMCGRs, 8.8% of sMCGRs, and 17.1% of cMCGRs reached the maximum excursion. Overall, 21.7% reached the maximum excursion. Within the pMCGR cohort, idiopathic and neuromuscular etiologies had a decline in lengthening achieved over time (p 0.001), while syndromic EOS demonstrated a preserved ability to lengthen over time (p = 0.51). When the etiological groups were compared with each other, the neuromuscular group had the least ability to lengthen over time (p = 0.001 versus syndromic, p = 0.02 versus idiopathic). The MCGR experiences the law of diminishing returns in patients with EOS. We found that only 21.7% of rods expanded to within 80% of the maximum excursion. Therapeutic Level III . See Instructions for Authors for a complete description of levels of evidence.
Publisher: MDPI AG
Date: 19-02-2023
DOI: 10.3390/JCM12041651
Abstract: Hip displacement is the second most common musculoskeletal deformity in children with cerebral palsy. Hip surveillance programs have been implemented in many countries to detect hip displacement early when it is usually asymptomatic. The aim of hip surveillance is to monitor hip development to offer management options to slow or reverse hip displacement, and to provide the best opportunity for good hip health at skeletal maturity. The long-term goal is to avoid the sequelae of late hip dislocation which may include pain, fixed deformity, loss of function and impaired quality of life. The focus of this review is on areas of disagreement, areas where evidence is lacking, ethical dilemmas and areas for future research. There is already broad agreement on how to conduct hip surveillance, using a combination of standardised physical examination measures and radiographic examination of the hips. The frequency is dictated by the risk of hip displacement according to the child’s ambulatory status. Management of both early and late hip displacement is more controversial and the evidence base in key areas is relatively weak. In this review, we summarise the recent literature on hip surveillance and highlight the management dilemmas and controversies. Better understanding of the causes of hip displacement may lead to interventions which target the pathophysiology of hip displacement and the pathological anatomy of the hip in children with cerebral palsy. We have identified the need for more effective and integrated management from early childhood to skeletal maturity. Areas for future research are highlighted and a range of ethical and management dilemmas are discussed.
Publisher: Springer Science and Business Media LLC
Date: 19-04-2021
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2015
Publisher: Springer Science and Business Media LLC
Date: 09-2013
DOI: 10.1016/J.JSPD.2013.07.001
Abstract: Retrospective, multicenter review of the spinopelvic parameters in young children with scoliosis. To describe sagittal alignment of the spine and pelvis in young children with scoliosis. The natural history of spinopelvic parameters has been defined for the first 10 years of life in normal children however, they have not been described for children with scoliosis. Such information is important because these values can be used as a baseline for the assessment of radiographic outcomes after surgical intervention. Seven measures of sagittal alignment were taken from standing lateral radiographs of 80 children with scoliosis (coronal Cobb angle greater than 50°) and compared with age-matched normal children described in the literature. Statistical analysis was performed using 2-tailed Student t tests (level of significance = .05) and Pearson correlation coefficient. Patients had a mean age of 4.8 years (range, 1-10 years) and a mean Cobb angle of 72.0° ± 16°. Mean sagittal spine parameters were sagittal balance (2.2 ± 4 cm), thoracic kyphosis (38.0° ± 20.8°), and lumbar lordosis (49.0° ± 16.6°). These values were similar to those of children without scoliosis. Mean sagittal pelvic parameters were: pelvic incidence (46.5° ± 15.8°), pelvic tilt (10.7° ± 13.6°), sacral slope (35.5° ± 12.1°), and pelvic radius (55.7° ± 21.3°). Pelvic incidence was not significantly different from that of age-matched normal children however, pelvic tilt was significantly higher and sacral slope was significantly lower in children with scoliosis. Sagittal plane spine parameters and some pelvic parameters were similar for young children with scoliosis versus age-matched normal children however, children with scoliosis showed signs of increased pelvic tilt and decreased sacral slope. These values can be used as a baseline for both the natural history and the assessment of radiographic outcomes after surgical intervention.
Publisher: BMJ
Date: 19-10-2016
Publisher: Springer Science and Business Media LLC
Date: 11-01-2022
DOI: 10.1007/S43390-021-00455-8
Abstract: To compare the outcomes of anterior Vertebral Body Tethering (AVBT) surgery between overweight and non-overweight patients. AIS/JIS patients with AVBT with 2-year follow-up from a multi-center pediatric spine database were evaluated pre-operatively, 1st post-operative erect, and 2 years post-operatively. ANOVA was used to compare 3 categories of BMI with significance as per Tukey-Kramer HSD post hoc test. Risk of scoliosis progression was analysed with Mid-P exact test. 121 patients (51 underweight, 58 normal, 12 overweight mean age 12.5 ± 1.6 yr BMI 18.8 ± 4.6 kg/m Our findings demonstrate that, as compared to normal weight and underweight patients, overweight patients did not have a statistically significant difference in intra-operative scoliosis correction or in risk of experiencing complication however, overweight patients had a risk ratio of 4.74 for progression of scoliosis during the growth modulation phase of treatment from first erect radiographs to minimum 2-year follow-up. III.
Publisher: Wiley
Date: 17-05-2023
DOI: 10.1111/DMCN.15637
Abstract: To determine the dose–response relationship of collagenase Clostridium histolyticum (CCH) on collagen content and the change in muscle fiber bundle stiffness after ex vivo treatment of adductor longus biopsies with CCH in children with cerebral palsy (CP). Biopsy s les of adductor longus from children with CP (classified in Gross Motor Function Classification System levels IV and V) were treated with 0 U/mL, 200 U/mL, 350 U/mL, or 500 U/mL CCH percentage collagen reduction was measured to determine the dose–response. Peak and steady‐state stresses were determined at 1%, 2.5%, 5%, and 7.5% strain increments Young's modulus was calculated. Eleven patients were enrolled (nine males, two females, mean age at surgery 6 years 5 months range: 2–16 years). A linear CCH dose–response relationship was determined. Peak and steady‐state stress generation increased linearly at 5.9/2.3mN/mm 2 , 12.4/5.3mN/mm 2 , 22.2/9.7mN/mm 2 , and 33.3/15.5mN/mm 2 at each percentage strain increment respectively. After CCH treatment, peak and steady‐state stress generation decreased to 3.2/1.2mN/mm 2 , 6.5/2.9mN/mm 2 , 12.2/5.7mN/mm 2 , and 15.4/7.7mN/mm 2 respectively ( p 0.004). Young's modulus decreased from 205 kPa to 100 kPa after CCH ( p = 0.003). This preclinical ex vivo study provides proof of concept for the use of collagenase to decrease muscle stiffness in in iduals with CP.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 2021
Abstract: A better understanding of early pain trajectories (patterns) following scoliosis surgery and how they relate to baseline patient characteristics and functional outcomes may allow for the development of mitigating strategies to improve patient outcomes. This was a prospective cohort study. Adolescents with idiopathic scoliosis were recruited across multiple centers. Latent growth mixture modeling techniques were used to determine pain trajectories over the first postoperative year. The median numerical rating scale for pain in the hospital following surgery for adolescent idiopathic scoliosis was 5.0. It improved to 1.0 by 6 weeks, and was maintained at by 3 to 12 months postoperatively. Three trajectories were identified, 2 of which involved moderate acute postoperative pain: 1 with good resolution and 1 with incomplete resolution by 1 year. The third trajectory involved mild acute postoperative pain with good resolution by 1 year. Membership in the “moderate pain with incomplete resolution” trajectory was predicted by higher baseline pain and anxiety, and patients in this trajectory reported worse quality of life than those in the trajectories with good resolution. Pain recovery following surgery for idiopathic scoliosis was found to be substantial during the first 6 weeks and continued up to 1 year. We identified 3 main trajectories, 2 with favorable outcomes and 1 with persistent pain and worse quality of life at 1 year postoperatively. The risk factors most associated with the latter trajectory included increased baseline pain and anxiety. Prognostic Level II . See Instructions for Authors for a complete description of levels of evidence.
Publisher: Informa UK Limited
Date: 08-2016
DOI: 10.2147/MDER.S113067
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-10-2021
DOI: 10.1097/BPO.0000000000001892
Abstract: Early-onset scoliosis (EOS) is common in children with cerebral palsy (CP). The effectiveness of magnetically controlled growing rods (MCGR) and the risk for unplanned return to the operating room (UPROR) remain to be studied in this patient population. The primary outcome of this study was to examine the frequency of UPROR between MCGRs as compared with traditional growth friendly (TGF) surgeries for children with EOS secondary to CP. Patients with EOS secondary to CP were prospectively identified from an international database, with data retrospectively analyzed. Scoliosis, kyphosis, T1-S1, and T1-T12 height were measured preoperation, immediate postoperation, and at minimum 2-year follow-up. The risk and etiology of UPRORs were compared between MCGR and TGF. Of the 120 patients that met inclusion criteria, 86 received TGF (age 7.5±0. 1.8 y mean follow-up 7.0±2.9 y) and 34 received MCGR (age 7.1±2.2 y, mean follow-up 2.8±0.0.5 y). Compared with TGF, MCGR resulted in significant improvements in maintenance of scoliosis ( P =0.007). At final follow-up, UPRORs were 8 of 34 patients (24%) for MCGR and 37 of 86 patients (43%) for TGF ( P =0.05). To minimize the influence of follow-up period, UPRORs within the first 2 years postoperation were evaluated: MCGR (7 of 34 patients, 21%) versus TGF (20 of 86 patients, 23% P =0.75). Within the first 2 years, etiology of UPROR as a percentage of all patients per group were deep infection (13% TGF, 6% MCGR), implant failure/migration (12% TGF, 9% MCGR), dehiscence (4% TGF, 3% MCGR), and superficial infection (4% TGF, 3% MCGR). The most common etiology of UPROR for TGF was deep infection and for MCGR was implant failure/migration. For patients with EOS secondary to CP, there was no difference in the risk of UPROR within the first 2 years postoperatively whether treated with TGF surgery or with MCGRs (23% TGF, 21% MCGR). Level III—retrospective cohort, therapeutic study.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2008
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 24-12-2020
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 02-08-2021
DOI: 10.1097/BPO.0000000000001898
Abstract: Methyl-CpG binding protein 2 (MECP2) disorders, including Rett syndrome and MECP2 duplication syndrome, are typified by profound intellectual disability, spasticity, and decline in gross motor function. Unlike scoliosis, linked to disease severity, little has been reported regarding the hip. The aim of this study was to report the prevalence and risk factors of hip displacement (HD) in MECP2 disorders. This was a retrospective, comparative study. Children with a genetically confirmed MECP2 disorder were included. The primary outcome measure was the prevalence of HD (migration percentage %). Secondary outcomes included age at HD onset, ambulatory status, presence of clinically relevant scoliosis, genetic severity, presence of seizures, and associated comorbidities. Analysis of proportions of categorical variables was performed using χ 2 testing ( P =0.05). Fifty-six patients (54 Rett syndrome and 2 MECP2 duplication syndrome), diagnosed at 6.6 (SD: 4.7) years, met the inclusion criteria. The prevalence of HD was 36% [onset, 7.7 (SD: 3.8) y]. Risk factors for HD were nonwalker status ( P =0.04), scoliosis ( P =0.001), and refractory epilepsy ( P =0.04). The prevalence of HD in MECP2 disorders is comparable to cerebral palsy, associated with proxy measures of disease severity. These results can be used to develop hip surveillance programs for MECP2 disorders, allowing for timely management. Level III.
Publisher: CMA Impact Inc.
Date: 08-2014
DOI: 10.1503/CJS.025613
Publisher: Wiley
Date: 09-2005
DOI: 10.1111/J.1440-1754.2005.00687.X
Abstract: Objectives: To study the relationships between motor type, topographical distribution and gross motor function in a large, population‐based cohort of children with cerebral palsy (CP), from the State of Victoria, and compare this cohort to similar cohorts from other countries. Methods: An inception cohort was generated from the Victorian Cerebral Palsy Register (VCPR) for the birth years 1990–1992. Demographic information, motor types and topographical distribution were obtained from the register and supplemented by grading gross motor function according to the Gross Motor Function Classification System (GMFCS). Results: Complete data were obtained on 323 (86%) of 374 children in the cohort. Gross motor function varied from GMFCS level I (35%) to GMFCS level V (18%) and was similar in distribution to a contemporaneous Swedish cohort. There was a fairly even distribution across the topographical distributions of hemiplegia (35%), diplegia (28%) and quadriplegia (37%) with a large majority of young people having the spastic motor type (86%). Conclusions: The VCPR is ideal for population‐based studies of gross motor function in children with CP. Gross motor function is similar in populations of children with CP in developed countries but the comparison of motor types and topographical distribution is difficult because of lack of consensus with classification systems. Use of the GMFCS provides a valid and reproducible method for clinicians to describe gross motor function in children with CP using a universal language.
Publisher: Elsevier BV
Date: 05-2013
DOI: 10.1016/J.CLINPH.2012.10.023
Abstract: To determine the percentage change in somatosensory evoked potential litude and the duration of spinal cord compression that can be tolerated intraoperatively in a rat model before there are significant post-operative functional deficits. Thirty two adult male Wistar rats were ided into four groups according to the percentage of induced SSEP signal loss all animals had pre-operative functional testing. Following surgical placement of a balloon catheter in the thoracic sub-laminar space, SSEPs were recorded while the spinal cord was compressed by inflation of the balloon. The recordings were terminated after a different percentage loss of SSEP litude in each group. Functional behavioral testing was repeated after 24 h. Only the group wherein the catheter was left inflated for 15 min after a complete (100%) loss of SSEP litude showed a significant deterioration in functional testing as compared to pre-operative baseline values. Functional testing remained normal for the groups in which termination of spinal cord compression occurred immediately after a decrease of SSEP litude to 50% or 100%. SSEP loss of up to 100% can be tolerated in a rat model of spinal cord compression as long as the compression is terminated immediately after the SSEP decrease is detected. Prolonged spinal cord compression, with concomitant SSEP decrease, can result in post-operative functional deficits despite mitigating procedures to remove the compression. This study is an important first step in providing basic science evidence for the establishment of acceptable "alarm criteria" during spinal surgery.
No related grants have been discovered for Jason J. Howard.