G. Dean MacEwen

Herniation of the Lumbar Disc in Children and Adolescents

Summary Of the hundreds of papers written on intervertebral lumbar disc herniation, very few have reported protruding lumbar intervertebral discs in children. Although surgical treatment of this problem in children has been well documented, we found no report of conservative treatment. This study concerns 23 patients under the age of 19 years who were treated for herniated lumbar intervertebral discs at the Alfred I. duPont Institute between 1963 and 1978. Thirteen patients were treated surgically and 10 were treated conservatively. The most common complaint in our patients was low back pain. We have found that, in the absence of neurological deficit, herniated lumbar discs in children and adolescents can be safely treated conservatively.

Neurologic risk management in scoliosis surgery.

Paraplegia resulting from the operative treatment of scoliosis is the complication most feared by surgeon and patient (5,26,31,50). Less devastating neurologic complications, including incomplete spinal cord injury and peripheral nerve injury, can also occur. Theoretically, the frequency of neurologic complications increases with more aggressive corrective techniques (50). Neurologic injury stemming from surgical treatment of scoliosis can be direct or indirect. The implications of such complications are profound, and prevention is paramount. The purpose of this paper is to review minimization of risk in scoliosis surgery. In addition, we review techniques for dealing with neurologic compromise and stress the need to maintain adequate communication with the patient and family.

Hip Arthroscopy for the Treatment of Children With Hip Dysplasia: A Preliminary Report

The use of arthroscopic techniques to diagnose and treat hip disorders in children provides the potential to limit the morbidity of current techniques.