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Dive into the research topics where Gary S. Shapiro is active.

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Featured researches published by Gary S. Shapiro.


Spine | 2003

Results of surgical treatment of adult idiopathic scoliosis with low back pain and spinal stenosis: a study of long-term clinical radiographic outcomes.

Gary S. Shapiro; Gaku Taira; Oheneba Boachie-Adjei

Study Design. A case series of adults with surgical treatment for adult idiopathic thoracolumbar and/or lumbar scoliosis, low back pain, and spinal stenosis was studied. Objective. To assess pain relief, curve correction, and complications after combined procedures consisting of decompression, spine fusion, and stabilization. Summary of Background Data. Only one publication has focused specifically at this group, and this was before the advent of modern segmental instrumentation. This is the first report of long-term follow-up evaluation in such a patient population. Methods. This study included 16 patients who underwent elective anterior and posterior surgical reconstruction for adult idiopathic thoracolumbar and/or lumbar scoliosis, spinal stenosis, and low back pain with a minimum follow-up period of 2 years. Radiographic findings, clinical results, and long-term outcome data were obtained using the Modified Scoliosis Research Society outcome instrument and the Oswestry Disability Back Pain Questionnaire. Results. Restoration of coronal and sagittal balance, or improvement thereof, was achieved in all the patients with balance problems. There was significant improvement in all outcome domains. Overall, 94% of the patients were satisfied with the surgery. Ten major complications occurred in 10 patients, 8 of whom required additional surgery. There were two minor complications. Conclusions. Combined symptoms of back pain and spinal stenosis require complex reconstructive surgery in adults with idiopathic thoracolumbar and/or lumbar scoliosis. Significant pain relief, functional restoration, and satisfaction can be achieved and maintained over the long term in the properly selected patient.


Spine | 2004

Cervical epidural abscess after epidural steroid injection.

Russel C. Huang; Gary S. Shapiro; Moe Lim; Harvinder S. Sandhu; Gregory E. Lutz; Richard J. Herzog

Study Design. This is a case report of a cervical epidural abscess presenting with neurologic deficits after cervical epidural steroid injection. Objective. To describe the presentation, diagnosis, treatment, and outcome of a rare complication of cervical epidural steroid injection. Summary of Background Data. Cervical epidural steroid injections are a commonly used modality in the treatment of cervical spine disease. Serious complications from the procedure are rare. There is only one previously reported case of cervical epidural abscess after cervical epidural injection in the literature. Materials and Methods. A case of cervical epidural abscess after epidural steroid injection is presented and the relevant literature is reviewed. Results. The patient had partial recovery of neurologic function within the first 24 hours after decompressive laminectomy, irrigation, and debridement. There were no perioperative complications. Intraoperative cultures permitted positive identification of the infecting organism and appropriate antibiotic selection. At 7-month follow-up, there was no recurrence of infection and the patient had recovered baseline neurologic function and neck pain status. Conclusions. Cervical epidural abscess is a rare but potentially devastating complication after epidural steroid injection. Neurologic compromise may occur. Timely diagnosis and appropriate treatment may result in good clinical outcomes.


Current Opinion in Pediatrics | 2001

Medical complications in scoliosis surgery.

Gary S. Shapiro; Daniel W. Green; Nunzia S. Fatica; Oheneba Boachie-Adjei

Several medical complications can occur after scoliosis surgery in children and adolescents. They include the syndrome of inappropriate antidiuretic hormone; pancreatitis; cholelithiasis; superior mesenteric artery syndrome; ileus; pnemothorax; hemothorax; chylothorax; and fat embolism. This review focuses on the pathophysiology, diagnosis, and treatment of the various conditions that occur after correction of spinal deformity. Attention is given to recent literature specifically related to scoliosis surgery. Surgical complications like urinary tract infection, wound infection, and hardware failure will not be addressed.


Spine | 2005

Multilevel spinal growth modulation with an anterolateral flexible tether in an immature bovine model.

Peter O. Newton; Fran D. Faro; Christine L. Farnsworth; Gary S. Shapiro; Fazir Mohamad; Stefan Parent; Kevin B. Fricka

Study Design. A bovine model was used to evaluate the effects of a multilevel anterolateral flexible tether in a growing spine. Objective. To evaluate the radiographic changes in a growing spine with a multilevel anterolateral tether. Summary of Background Data. Spinal growth modulation has long been considered as a conceptually attractive and elegant possible alternative to arthrodesis in the treatment of idiopathic scoliosis. Although some experimental studies have described spinal growth modulation, few have described a purely mechanical tether. Clinical studies of spinal epiphysiodesis have described inconsistent curve stabilization and/or correction. Methods. A total of 33 one-month-old male calves underwent a single thoracotomy and placement of vertebral screws at T6–T9. In 11 animals, one screw per level was connected by a 3/16 in. stainless steel cable (single tether). In 11 animals, two screws per level were connected by two cables (double tether). In the remaining 11 animals, single screws in each level were left unconnected (control). After 6 months, the spines were harvested and underwent radiographic analysis. Results. In the control group, there was little change in the coronal and sagittal measurements during the survival period. In the single tether group, there was variable instrumentation fixation and inconsistent creation of coronal deformity, which ranged from 0° to 31°. The double-tether group had more consistent creation of deformity, ranging from 23° to 57°. Conclusions. Given adequate bony fixation, a flexible lateral spinal tether can affect growth modulation. This technique of growth modulation may serve as a future fusionless method of correction in a growing patient with scoliosis.


Spine | 2002

The Use of Epoetin Alfa in Complex Spine Deformity Surgery

Gary S. Shapiro; Oheneba Boachie-Adjei; Sripad H. Dhawlikar; Lindy S. Maier

Study Design. A prospective, randomized trial comparing Epoetin alfa (Procrit) with placebo saline injection to determine effectiveness in increasing erythropoietic recovery in complex spine deformity surgery. Objectives. To determine if Epoetin alfa can allow preoperative autologous donation completion more effectively and reduce perioperative homologous blood transfusion. Summary of Background Data. The use of Epoetin alfa has been studied, primarily in the arthroplasty literature, for its effectiveness in decreasing transfusion requirements and increasing hemoglobin levels. It has not been studied in patients undergoing complex spine deformity surgery. Methods. A total of 48 patients were prospectively randomized into an Epoetin alfa group and a control group. All patients attempted to donate 4 units of preoperative autologous donation at weekly intervals; 40,000 units of Epoetin alfa were injected subcutaneously at the time of preoperative autologous donation in the Epoetin alfa group. Hematocrit levels were recorded weekly during the donation process and daily in the preoperative period. Results. Preoperative autologous donation was completed more effectively in the patients receiving Epoetin alfa. Epoetin alfa resulted in statistically higher hematocrit levels during preoperative autologous donation and perioperatively (P < 0.005). Homologous transfusion was decreased by 2.4 units and hospital stay was 1.8 days shorter in patients receiving Epoetin alfa. Conclusion. Patients who received Epoetin alfa were able to complete preoperative autologous donation more effectively, increase erythropoietic recovery, decrease homologous transfusion requirements, and had shorter hospital stays.


Spine | 2005

Thoracic vertebral screw impingement on the aorta in an in vivo bovine model

Fran D. Faro; Christine L. Farnsworth; Gary S. Shapiro; Fazir Mohamad; Klane K. White; Eric Breisch; Andrew Mahar; Tucker Tomlinson; Maneesh Bawa; Mark A. Gomez; Peter O. Newton

Study Design. A bovine model was used to evaluate the effects of thoracic vertebral screw impingement of the aorta. Objectives. To evaluate the histologic and biomechanical changes in aortic wall tissue that was severely impinged by abutting instrumentation. Summary of Background Data. Case reports of vascular injury associated with spinal instrumentation generally describe intraoperative injury; some report delayed presentation of large vessel damage. Risks associated with placing instrumentation adjacent to large vessels are largely unknown. Methods. Six 1-month-old calves underwent left-sided thoracotomies, exposing the anterior thoracic spine and aorta. With the heads removed, screws were inserted in reverse fashion into T6 through T11, leaving the screw tips 1 cm proud and abutting the aorta. After 3, 6, or 12 months (2 calves each), the spines were resected with the adjacent aorta and underwent radiographic, histologic, and biomechanical testing. Results. Computed tomography revealed varying degrees of vessel impingement. Although there were no frank ruptures, 96% of aortic specimens showed histopathologic changes, including 52% with wall thinning; 43% were no longer impinged, yet 60% of these had increased collagen (scar). Biomechanical testing of screw-impinged aortas demonstrated a lower failure stress (1.2 ± 0.5 N/mm2 vs. 1.8 ± 0.4 N/mm2, P = 0.016) but no difference in failure strain (42 ± 9% vs. 32 ± 10%, P = 0.06) than controls. Conclusions. Major impingement of vertebral screws on the aorta caused acute and chronic histopathologic and biomechanical changes in the vessel wall. This model represents a severe form of vessel penetration by a screw that confirms such a “worst case” scenario results in marked compromise of the vessel wall integrity. The sequelae of less severe impingement are unknown.


Skeletal Radiology | 2001

Spinal epidural hemangioma related to pregnancy

Gary S. Shapiro; Peter J. Millett; Edward F. DiCarlo; Douglas N. Mintz; Francis W. Gamache; Bernard A. Rawlins

Abstract We report the case of a 39-year-old woman with adolescent idiopathic scoliosis presenting with myelopathy secondary to a spinal epidural hemangioma. MRI showed an epidural soft tissue mass within the spinal canal between T5 and T9 with severe spinal cord compression. Symptoms had a temporal relationship to her pregnancy. Surgical removal of the epidural hemangioma rapidly relieved her symptoms and neurologic deficits. Follow-up examination 2 years later demonstrated normal motor and sensory function, without any neurologic sequelae or progression of deformity.


Global Spine Journal | 2015

Extensive Deep Venous Thrombosis Resulting from Anterior Lumbar Spine Surgery in a Patient with Iliac Vein Compression Syndrome: A Case Report and Literature Review

Deepak Reddy; Mark M. Mikhael; Gary S. Shapiro; Tony Farrell

Study Design Case report. Objective Although May-Thurner syndrome or iliac vein compression syndrome is covered in the vascular literature, it remains absent from the orthopedic and neurosurgery literature and has not been previously reported to occur in concordance with spine surgery. We review the salient points of disease presentation, diagnosis, and treatment. Methods A 33-year-old woman was followed postoperatively via clinical and radiographic findings. Her presentation, operative treatment, postoperative extensive deep venous thrombosis (DVT) formation, and management are described. Results We present a unique case of a healthy 33-year-old woman who developed an extensive left iliac vein DVT after anterior lumbar spine fusion. Although she had multiple risk factors for thrombosis, the size of the thrombus was atypical. A subsequent venogram showed compression of the left common iliac vein by the right common iliac artery, consistent with May-Thurner syndrome. Conclusions May-Thurner syndrome or iliac vein compression syndrome is a rare diagnosis that is absent from the spine literature. The condition can predispose patients to extensive iliac vein DVT. The contributing anatomy and subsequent clot often require catheter-directed thrombolysis and stenting to achieve a favorable outcome.


Global Spine Journal | 2012

High-grade adult isthmic L5-s1 spondylolisthesis: a report of intraoperative slip progression treated with surgical reduction and posterior instrumented fusion.

Mark M. Mikhael; Gary S. Shapiro; Jeffrey C. Wang

Adult isthmic spondylolisthesis most commonly occurs at the L5–S1 level of the lumbar spine. Slip progression is relatively rare in adults with this condition and slippage is typically associated with advanced degeneration of the disk below the pars defect. When symptomatic, radiculopathy is the typical complaint in adults with isthmic spondylolisthesis. When considering options for surgical treatment of adult isthmic spondylolisthesis, the surgeon must consider several different options, such as decompression, fusion, instrumentation, reduction, and type of bone graft to be used. All of these decisions must be individualized as deemed appropriate for each particular patient. This report presents a case of intraoperative slip progression of a L5–S1 adult isthmic spondylolisthesis to a high-grade slip, which was treated with complete surgical reduction and posterior instrumented fusion. This case demonstrates the potential instability of this condition in adults and has not been previously reported. The case details and images are reviewed and the intraoperative decisions, treatment options, and patient outcome are discussed.


Techniques in Orthopaedics | 2001

The Use of Constrained Acetabular Sockets

Edwin P. Su; Gary S. Shapiro; Paul M. Pellicci

Summary Recurrent instability after total hip replacement is a complex problem with extensive literature detailing multiple etiologies and solutions. It has been shown that the success of surgical management depends on the identification of the etiology. Unfortunately, in certain situations, there may not be an optimal solution for dealing with the cause, or the etiology may remain unidentified. In these cases, the success rate of surgical management of unstable total hip replacement is only 40 to 50%. Constrained acetabular liners were developed to address the problem of recurrent instability by holding the femoral head captive within the socket. The authors’ experience with attaining joint stability using one type of constrained liner has far surpassed the success rates achieved by other means. The intermediate follow-up after implantation of a constrained liner has not demonstrated significant rates of component wear or loosening. The authors reserve the use of a constrained liner for situations in which there are inadequate soft tissue, a deficient abductor mechanism, or neuromuscular disorders. Poor patient compliance or instability without a clear etiology are relative indications for its use.

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Paul M. Pellicci

Hospital for Special Surgery

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Thomas P. Sculco

Hospital for Special Surgery

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Daniel E. Weiland

Hospital for Special Surgery

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Douglas E. Padgett

Hospital for Special Surgery

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Douglas N. Mintz

Hospital for Special Surgery

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Fran D. Faro

University of California

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Peter O. Newton

Boston Children's Hospital

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