Per Trobisch

Low-density versus high-density thoracic pedicle screw constructs in adolescent idiopathic scoliosis: do more screws lead to a better outcome?

BACKGROUND CONTEXT Thoracic pedicle screw (TPS) constructs have improved curve correction measurements compared with hook and hybrid constructs in the treatment of adolescent idiopathic scoliosis (AIS), but the optimal implant density, or the number of screws per level, remains unknown in the treatment of flexible thoracic curves. PURPOSE To determine how implant density affects clinical outcome, radiographic outcome, and cost in the treatment of Lenke Curve Type I AIS. STUDY DESIGN A retrospective clinical study. PATIENT SAMPLE Ninety-one consecutive AIS patients with Lenke Type I curves who underwent surgical correction with a minimum follow-up of 24 months. OUTCOME MEASURES Radiographic outcomes included assessment of preoperative and 2-year postoperative thoracic Cobb angle, T5-T12 kyphosis, and curve flexibility. We also assessed SRS-22 outcome measures and thoracic angle of trunk rotation (ATR) before surgery and at the 2-year postoperative time point. The cost of each construct was also evaluated. METHODS Bivariate analysis was conducted between implant density and the following factors: percent correction of the major curve, ATR, and change in kyphosis. The correlation between curve flexibility and percent correction of the major curve was determined. Patients were then divided into two groups: the low-density (LD) TPS group defined by implant density below the mean number of screws per level for the entire cohort (less than 1.3 screws per level) and the high-density (HD) TPS group defined by implant density above the mean number of screws per level (more than 1.3 screws per level). Independent sample t tests were used to compare demographic data as well as radiographic and clinical outcomes at baseline and at follow-up between the two groups. RESULTS Sixty-one female and 30 male patients met inclusion criteria. No significant correlations were found between implant density and the following parameters: percent correction of the major curve (p=.25), ATR (p=.75), and change in T5-T12 kyphosis (p=.40). No correlation was found between curve flexibility and percent correction of the major curve (p=.54). The LD group consisted of 57 patients, whereas the HD group had 34 patients. There were no differences between the HD group and the LD group in regard to major curve correction, change in T5-T12 kyphosis, or change in ATR. Total implant costs were significantly higher in the HD group (

Choosing Fusion Levels in Adolescent Idiopathic Scoliosis

13,272 vs.

Aggressive surgical treatment of periprosthetic femur fractures can reduce mortality: comparison of open reduction and internal fixation versus a modular prosthesis nail.

10,819; p<.01). The SRS-22 image domain and overall score improved at 2 years within both groups, but there were no group differences in any of the SRS-22 domains or the overall score. CONCLUSIONS We identified no clinical, radiographic, perioperative, or complication-related advantage of constructs with higher TPS implant density in this patient cohort with flexible idiopathic scoliosis. Cost was significantly higher with HD constructs in comparison with LD constructs. Optimal implant density chosen by the surgeon should rely on a number of factors including curve magnitude and rigidity, bone density, and desired correction.

Sagittal Spinopelvic Parameters in Scheuermann's Kyphosis: A Preliminary Study.

&NA; Correct identification of fusion levels in surgical planning for the management of adolescent idiopathic scoliosis is a complex task. Several classification systems and algorithms exist to assist surgeons in determining the appropriate levels to be instrumented. The Lenke classification is the benchmark system. Among the many factors and measurements that are taken into account when selecting the proper upper instrumented vertebra and lower instrumented vertebra are planning for selective fusion; preserving motion segments; preventing proximal and/or distal junctional kyphosis, shoulder imbalance, and neck pain; and maintaining short fusion lengths. Existing treatment algorithms do not account for every exception, and further research is required to improve long‐term surgical outcomes.

Validity of Cobb angle measurements using digitally photographed radiographs

Objectives: The purpose of this study was to determine if immediate full weightbearing after surgical treatment for periprosthetic femur fractures can decrease perioperative and total mortality. Design: Retrospective review. Setting: Level II trauma center. Patients: Fifty-two consecutive patients with a periprosthetic femur fracture during a 16-year time period. Intervention: Comparison of open reduction and internal fixation with a plate (non- or partial postoperative weightbearing) versus stem exchange to a modular prosthesis nail (immediate full postoperative weightbearing). Main Outcome Measurements: Six-month and total mortality using a Kaplan-Meier survival analysis. An additional matched subanalysis was performed for Vancouver Type B1 fractures. Results: Patients permitted immediate postoperative full weightbearing had a significantly decreased total (P < 0.001) and 6-month mortality (P = 0.007). Subanalysis of patients with Vancouver Type B1 fractures also showed decrease in mortality, which was significant for total (P < 0.005) but not for 6-month mortality (P = 0.121). Conclusion: Treatment of periprosthetic femur fractures with femoral component exchange to a modular prosthetic nail that allows immediate postoperative full weightbearing may decrease mortality.

Clinical and demographic characteristics of online community members—does it represent reality?

STUDY DESIGN Retrospective, controlled, clinical study. OBJECTIVES To define the average values for sagittal spinopelvic parameters including pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS) in Scheuermanns kyphosis (SK); evaluate the differences in spinopelvic parameters among patients with SK and unaffected normal controls; and evaluate the correlation of various sagittal spinopelvic parameters to each other in SK and normal controls. METHODS Prospectively collected radiographic data from a study on SK were compared with those from previously published series of unaffected patients. Measures were made according to standard, defined measurement methods. Parameters measured included PT, PI, SS, thoracic kyphosis, lumbar lordosis, and radiographic sagittal alignment. Values were compared using independent-samples t test. Pearson correlation coefficient was used to analyze relationships between variables. RESULTS A total of 47 patients with SK and 50 control patients, mean age 16.1 and 13.5 years, respectively, were included. In SK, average PI was 42°, average PT was 7°, and average SS was 35°. These values were not different from those of normal controls (PI, 46° [p = .084]; PT, 8° [p = .476]; SS, 37° [p = .162]). Pelvic incidence directly correlated with lordosis in both groups (p < .005). T5-12 kyphosis correlated with lordosis in normal controls (p ≤ .05) but not in the SK group. Kyphosis in SK as quantified by greatest measurable Cobb angle did not correlate with PI or lordosis. CONCLUSIONS Sagittal pelvic alignment in patients with SK is not different from that in normal subjects. Furthermore, in SK thoracic kyphosis did not correlate with any distal region of the spine (lumbar or pelvic). Further understanding of the relationship between sagittal spinopelvic alignment in various conditions causing spinal deformity will lead to better treatment of these conditions.

Postoperative functional rehabilitation after repair of quadriceps tendon ruptures: a comparison of two different protocols

BACKGROUND CONTEXT Advances in technology are influencing the way that medical information is archived and shared. Considering that an estimated two-thirds of the world has little or no orthopedic care, high demand exists for adequate consultation regarding diagnostic images in orthopedic specialties. PURPOSE To validate the use of photographed scoliosis films for the accurate interpretation of Cobb angles. STUDY DESIGN Retrospective review. PATIENT SAMPLE Thirty scoliosis radiographs. OUTCOME MEASURE Cobb angle. METHODS Thirty scoliosis radiographs were photographed using a digital camera from a straight and a 45° angle position. Cobb angles were then measured on the digital images using standard measurement software. Comparison was made between two types of curves: convex and concave, relative to the left side (side for the angled position). RESULTS There was excellent reproducibility between the measurements of the conventional radiographs and the photographs taken from a straight on position, p value of .97 for convex curves and p value of .98 for concave curves. Photographs taken from a 45° angle significantly increased the magnitude of the curve convex to the angle (p=.001). CONCLUSION Sharing photographs of scoliosis radiographs can be done with reliability if the image is taken directly in front of the viewbox rather than at an oblique angle; pictures taken at oblique angles are prone to misinterpretation of curve magnitude.

Disease severity and treatment in adolescent idiopathic scoliosis: the impact of race and economic status

BACKGROUND The decision to undergo surgery for scoliosis is shared between the physician, patient, and family. In an effort to obtain objective data regarding scoliosis surgery, patients often use the Internet, which includes sharing experiences in online communities. To this end, physicians have limited knowledge about disease-specific online communities. PURPOSE To analyze the clinical and demographic characteristics of patients who use disease-specific online communities. STUDY DESIGN A retrospective clinical study. PATIENT SAMPLE One hundred ninety-five patients with scoliosis who are also members of a popular scoliosis-specific online community. MAIN OUTCOME MEASURES Five domains of the Scoliosis Research Society-22 (SRS-22) quality-of-life questionnaire: function, pain, mental health, self-image, and satisfaction. METHODS An online questionnaire was submitted by members of a scoliosis-specific online community. One hundred ninety-five patients with scoliosis fulfilled the inclusion criteria, which represented 54% of all active members who have logged into this community during the time of data collection. A descriptive analysis was performed for demographic and clinical characteristics. RESULTS Analysis revealed a bimodal age distribution. Most online members were female (74%) and underwent surgical treatment (78%). Of all surgical patients, 52% had surgery between the age of 10 and 18 years. The average time since surgery (follow-up) was 10 years and 9 months. A revision rate of 17% was calculated, which increased with longer follow-up. Five of nine surgical subgroups significantly outperformed nonsurgical patients in regards of SRS-22 total scores. CONCLUSION This study supports that members from an online scoliosis community may be the representative sample of the general scoliosis patient population. The information obtained may be useful for physicians to understand patient concerns and mitigate treatment expectations when counseling patients.