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Dong-wook Rha - One of the best experts on this subject based on the ideXlab platform.
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Effect of upper limb deformities on gross motor and upper limb functions in children with spastic cerebral palsy
Research in Developmental Disabilities, 2011Co-Authors: Eun Sook Park, Eun Geol Sim, Dong-wook RhaAbstract:The aims of this study were to investigate the nature and extent of upper limb deformities via the use of various classifications, and to analyze the relationship between upper limb deformities and gross motor or upper limb functionality levels. Upper extremity data were collected from 234 children with spastic cerebral palsy (CP) who were admitted to the university hospital for intensive rehabilitation. Upper limb deformities were classified according to the Zancolli classification for finger and wrist extension ability, the Gshwind and Tonkin classification for supination ability, and the House classification for thumb-in-palm Deformity. Digital Deformity was also classified. Upper limb function was assessed using the Upper Extremity Rating Scale (UERS) and the Upper Limb Physician's Rating Scale (ULPRS). Gross motor function was assessed using the Gross Motor Functional Classification System (GMFCS). Among the 234 children observed, 70.5% had a limitation in forearm supination, and 62.8% had problems with wrist and finger extension in at least one limb. Thumb-in-palm Deformity of at least one hand was found in 47.0% of patients. Swan neck Deformity was the most common finger Deformity. Upper limb functional measures, the ULPRS and the UERS, significantly correlated with the degree of upper limb Deformity, as assessed by the Gschwind and Tonkin, Zancolli, and House classifications. Further, the degree of upper limb Deformity was significantly related to the GMFCS level in children with bilateral CP, but not in children with unilateral CP. Limitation of forearm supination was the most common upper limb Deformity in children with spastic CP. The degree of upper limb Deformity significantly affected upper limb function in these children.
Gregory M. Mundis - One of the best experts on this subject based on the ideXlab platform.
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Prevalence and type of cervical Deformity among 470 adults with thoracolumbar Deformity.
Spine, 2014Co-Authors: Justin S. Smith, Frank J. Schwab, Virginie Lafage, Christopher I. Shaffrey, Themistocles S. Protopsaltis, Eric O. Klineberg, Munish C. Gupta, Justin K. Scheer, Gregory M. MundisAbstract:STUDY DESIGN Multicenter, prospective, consecutive case series. OBJECTIVE To assess prevalence and type of cervical Deformity among adults with thoracolumbar (TL) Deformity and to assess for associations between cervical deformities and different types of TL deformities. SUMMARY OF BACKGROUND DATA Cervical Deformity can present concomitantly with TL Deformity and have implications for the management of TL Deformity. METHODS Multicenter, prospective, consecutive series of adult (age >18 yr) patients with TL Deformity. Parameters included pelvic tilt (PT), pelvic incidence (PI), lumbar lordosis (LL), C2-C7 sagittal vertical axis (C2-C7SVA), C7-S1SVA, and C2-C7 lordosis. Cervical Deformity was defined as cervical lordosis more than 0° (cervical kyphosis [CK]) or C2-C7SVA more than 4 cm (cervical positive sagittal malalignment [CPSM]). Patients were stratified by the Scoliosis Research Society-Schwab classification of adult TL Deformity, including curve type (N = sagittal Deformity, T = thoracic scoliosis, L = lumbar scoliosis, and D = T + L scoliosis) and modifier grades: PT (0: 30°), C7-S1SVA (0: 9.5 cm), and PI-LL mismatch (0: 20°). RESULTS A total of 470 patients met criteria (mean age = 52 yr). Mean cervical lordosis and C2-C7SVA were -8° and 3.2 cm, respectively. CK and CPSM prevalence were 31% and 29%, respectively, and prevalence of CK and/or CPSM was 53%. CK prevalence differed by curve type (N = 15%, L = 27%, D = 37%, T = 49%; P < 0.001); CPSM prevalence did not differ by curve type (P = 0.19). Higher PT grades had lower CK prevalence (0 = 40%, += 27%, ++= 15%; P < 0.001) but greater CPSM prevalence (0 = 23%, += 28%, ++= 45%; P = 0.001). Similarly, higher SVA grades had lower CK prevalence (0 = 40%, += 23%, ++= 11%; P < 0.001) but greater CPSM prevalence (0 = 24%, += 24%, ++= 48%; P < 0.001). Higher PI-LL grades had lower CK prevalence (0 = 35%, += 31%, ++= 22%; P = 0.034) but no CPSM association (P = 0.46). CONCLUSION Cervical Deformity is highly prevalent (53%) in adult TL Deformity. C7-S1SVA, PT, and PI-LL modifiers are associated with cervical Deformity prevalence. These findings suggest that TL Deformity evaluation should include assessment for concomitant cervical Deformity and that further study is warranted to define their potential clinical impact. LEVEL OF EVIDENCE 3.
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the minimally invasive spinal Deformity surgery algorithm a reproducible rational framework for decision making in minimally invasive spinal Deformity surgery
Neurosurgical Focus, 2014Co-Authors: Praveen V Mummaneni, Justin S. Smith, Christopher I. Shaffrey, Gregory M. Mundis, Lawrence G Lenke, Paul Park, Michael Y Wang, Frank La Marca, David O Okonkwo, Bertrand MoalAbstract:Object Minimally invasive surgery (MIS) is an alternative to open Deformity surgery for the treatment of patients with adult spinal Deformity. However, at this time MIS techniques are not as versatile as open Deformity techniques, and MIS techniques have been reported to result in suboptimal sagittal plane correction or pseudarthrosis when used for severe deformities. The minimally invasive spinal Deformity surgery (MISDEF) algorithm was created to provide a framework for rational decision making for surgeons who are considering MIS versus open spine surgery. Methods A team of experienced spinal Deformity surgeons developed the MISDEF algorithm that incorporates a patient's preoperative radiographic parameters and leads to one of 3 general plans ranging from MIS direct or indirect decompression to open Deformity surgery with osteotomies. The authors surveyed fellowship-trained spine surgeons experienced with spinal Deformity surgery to validate the algorithm using a set of 20 cases to establish interobser...
Robert S Rozbruch - One of the best experts on this subject based on the ideXlab platform.
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validation of a modified scoliosis research society instrument for patients with limb Deformity the limb Deformity scoliosis research society ld srs score
Journal of Limb Lengthening & Reconstruction, 2016Co-Authors: Peter D Fabricant, Eugene W Borst, Stuart A Green, Robert G Marx, Austin T Fragomen, Robert S RozbruchAbstract:Background: Despite the large negative effect of limb Deformity on health-related quality of life (QoL), there exists no patient-reported instrument to quantify this impact. Rather, limb Deformity research has been performed using global QoL measurements concurrently with joint-specific and/or arthritis outcome scales, thereby requiring the completion of multiple instruments. Furthermore, joint- and arthritis-specific instruments focus on the impact pain has on function, whereas limb deformities may be pain-free with greater social and functional impairment. The purpose of this study was to validate a patient-reported instrument to quantify limb Deformity-related QoL. Materials and Methods: Because of the similarities with regard to pain, function, and body image between limb Deformity and scoliosis, the Scoliosis Research Society-30 (SRS-30) spine Deformity instrument was modified such that the words back and trunk were replaced with limb to create a novel instrument: the limb Deformity-SRS (LD-SRS). Testing for construct validity (both convergent and discriminant), reliability, floor and ceiling effects, and minimal clinically important difference (MCID) was performed in a validation cohort of 62 subjects aged 18 years or older with nonarthritic, unilateral lower extremity Deformity. Results: Scale reliability was excellent (test-retest reliability, intraclass correlation coefficient = 0.977; internal consistency, Cronbach's alpha = 0.906), scores were normally distributed, and there were no floor or ceiling effects. There was also robust construct validity: convergent validity testing revealed positive correlations between the LD-SRS and all short-form-36 domains, the American Academy of Orthopaedic Surgeons-Lower Limb Module, and higher scores in those who were postcorrection. Discriminant validity was demonstrated with no correlations between the LD-SRS and subject age, sex, body mass index, surgeon-scored Limb Lengthening and Reconstruction Society-AIM Index, or surgeon-generated Deformity measurements. MCID was calculated to be 0.3 (on a 4.0-point scale). Conclusions: The LD-SRS score is a reliable and valid instrument to measure limb Deformity-related QoL in patients with nonarthritic lower extremity Deformity. It is a valuable tool which allows clinicians to quantify patients' Deformity-related QoL with a single instrument, rather than repurposing scales which have been validated for other conditions and have limited applicability to the unique challenges of treating patients with a lower limb Deformity. Level of Evidence: Diagnostic, Level 2.
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correction of tibial Deformity with use of the ilizarov taylor spatial frame
Journal of Bone and Joint Surgery American Volume, 2006Co-Authors: Robert S Rozbruch, Austin T Fragomen, Svetlana IlizarovAbstract:The Ilizarov-Taylor Spatial Frame (TSF; Smith and Nephew, Memphis, Tennessee) is a powerful tool for correcting tibial Deformity1-6. A specialized feature of the TSF is its virtual hinge, which allows for the simultaneous gradual correction of multiplanar deformities and limb-lengthening through one osteotomy site. The power of the spatial frame lies in its precise control over the final limb length and alignment and in its ability to correct a residual Deformity. The stability of this multiplanar circular fixator permits early weight-bearing and provides an ideal environment for both new-bone formation and soft-tissue healing. The classic principles of the Ilizarov method are followed to ensure proper frame application. The TSF web-based software is user-friendly and has greatly simplified the planning of the correction of an oblique plane Deformity by utilizing standard anterior-posterior and lateral radiographic measurements. Computer-generated schedules and easy-to-read struts have greatly simplified patient involvement, which is crucial to the success of this technique. ### Preoperative Planning Patients are evaluated clinically by a history and physical examination including observation of gait. Special attention is directed toward the assessment of leg length, mechanical axis deviation, and rotational alignment (Fig. 1). An erect bipedal 51-in (130-cm) radiograph in the frontal plane is made. If there is a leg-length discrepancy, then blocks are placed under the affected foot to level the pelvis, and the block height is recorded. Accurate limb lengths are measured in this way. Sagittal Deformity about the knee is evaluated with a 36-in (91-cm) lateral radiograph made with the knee in full extension. Routine anteroposterior and lateral radiographs of the tibia are made as well. Ankle Deformity should be evaluated with the x-ray beam centered on the ankle. Mechanical axis deviation is determined with use of the malalignment test7,8 (Fig. 2). The lateral distal femoral angle, …
Bertrand Moal - One of the best experts on this subject based on the ideXlab platform.
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the minimally invasive spinal Deformity surgery algorithm a reproducible rational framework for decision making in minimally invasive spinal Deformity surgery
Neurosurgical Focus, 2014Co-Authors: Praveen V Mummaneni, Justin S. Smith, Christopher I. Shaffrey, Gregory M. Mundis, Lawrence G Lenke, Paul Park, Michael Y Wang, Frank La Marca, David O Okonkwo, Bertrand MoalAbstract:Object Minimally invasive surgery (MIS) is an alternative to open Deformity surgery for the treatment of patients with adult spinal Deformity. However, at this time MIS techniques are not as versatile as open Deformity techniques, and MIS techniques have been reported to result in suboptimal sagittal plane correction or pseudarthrosis when used for severe deformities. The minimally invasive spinal Deformity surgery (MISDEF) algorithm was created to provide a framework for rational decision making for surgeons who are considering MIS versus open spine surgery. Methods A team of experienced spinal Deformity surgeons developed the MISDEF algorithm that incorporates a patient's preoperative radiographic parameters and leads to one of 3 general plans ranging from MIS direct or indirect decompression to open Deformity surgery with osteotomies. The authors surveyed fellowship-trained spine surgeons experienced with spinal Deformity surgery to validate the algorithm using a set of 20 cases to establish interobser...
Frank J. Schwab - One of the best experts on this subject based on the ideXlab platform.
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Prevalence and type of cervical Deformity among 470 adults with thoracolumbar Deformity.
Spine, 2014Co-Authors: Justin S. Smith, Frank J. Schwab, Virginie Lafage, Christopher I. Shaffrey, Themistocles S. Protopsaltis, Eric O. Klineberg, Munish C. Gupta, Justin K. Scheer, Gregory M. MundisAbstract:STUDY DESIGN Multicenter, prospective, consecutive case series. OBJECTIVE To assess prevalence and type of cervical Deformity among adults with thoracolumbar (TL) Deformity and to assess for associations between cervical deformities and different types of TL deformities. SUMMARY OF BACKGROUND DATA Cervical Deformity can present concomitantly with TL Deformity and have implications for the management of TL Deformity. METHODS Multicenter, prospective, consecutive series of adult (age >18 yr) patients with TL Deformity. Parameters included pelvic tilt (PT), pelvic incidence (PI), lumbar lordosis (LL), C2-C7 sagittal vertical axis (C2-C7SVA), C7-S1SVA, and C2-C7 lordosis. Cervical Deformity was defined as cervical lordosis more than 0° (cervical kyphosis [CK]) or C2-C7SVA more than 4 cm (cervical positive sagittal malalignment [CPSM]). Patients were stratified by the Scoliosis Research Society-Schwab classification of adult TL Deformity, including curve type (N = sagittal Deformity, T = thoracic scoliosis, L = lumbar scoliosis, and D = T + L scoliosis) and modifier grades: PT (0: 30°), C7-S1SVA (0: 9.5 cm), and PI-LL mismatch (0: 20°). RESULTS A total of 470 patients met criteria (mean age = 52 yr). Mean cervical lordosis and C2-C7SVA were -8° and 3.2 cm, respectively. CK and CPSM prevalence were 31% and 29%, respectively, and prevalence of CK and/or CPSM was 53%. CK prevalence differed by curve type (N = 15%, L = 27%, D = 37%, T = 49%; P < 0.001); CPSM prevalence did not differ by curve type (P = 0.19). Higher PT grades had lower CK prevalence (0 = 40%, += 27%, ++= 15%; P < 0.001) but greater CPSM prevalence (0 = 23%, += 28%, ++= 45%; P = 0.001). Similarly, higher SVA grades had lower CK prevalence (0 = 40%, += 23%, ++= 11%; P < 0.001) but greater CPSM prevalence (0 = 24%, += 24%, ++= 48%; P < 0.001). Higher PI-LL grades had lower CK prevalence (0 = 35%, += 31%, ++= 22%; P = 0.034) but no CPSM association (P = 0.46). CONCLUSION Cervical Deformity is highly prevalent (53%) in adult TL Deformity. C7-S1SVA, PT, and PI-LL modifiers are associated with cervical Deformity prevalence. These findings suggest that TL Deformity evaluation should include assessment for concomitant cervical Deformity and that further study is warranted to define their potential clinical impact. LEVEL OF EVIDENCE 3.
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patient evaluation and clinical assessment of adult spinal Deformity
Journal of Bone and Joint Surgery American Volume, 2012Co-Authors: Adam L Wollowick, Steven D Glassman, Joseph H Perra, Frank J. SchwabAbstract:The clinical evaluation of adults with spinal Deformity can be challenging for both general orthopaedic surgeons and spinal specialists. To properly treat these patients, the physician must be aware of the various types of adult spinal Deformity and the basic principles of spinal misalignment. A complete patient assessment must include a thorough history and physical examination. Appropriate imaging studies can be used to characterize the extent of the Deformity and determine the need for surgical intervention or referral to a spine specialist. The ultimate goal of the evaluation of an adult with spinal Deformity is to determine the impact of the Deformity on the patient's quality of life, including the ability to work and perform activities of daily living. For patients considering surgical treatment, additional factors must be included in the assessment because of the high rate of complications associated with adult Deformity procedures.
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The SRS Classification for Adult Spinal Deformity
2006Co-Authors: Thomas G. Lowe, Sigurd Berven, Frank J. Schwab, Keith H. BridwellAbstract:Adult spinal Deformity is a common disorder that can have a significant and measurable impact on health-related quality of life. The adult with spinal Deformity presents with clinical symptoms and radiographic findings that are distinct from the adolescent with spinal Deformity. Important differences between the adult and the adolescent with spinal Deformity include patterns of Deformity, degenerative components, the natural history of Deformity progression, clinical symptoms, and presentation. The goals of operative and nonoperative care, and surgical strategies for achieving these goals of care, can differ significantly between adolescent and adult patients. Deformity in the adult spine is frequently characterized by associated degenerative changes, including spinal stenosis, spondylolisthesis, rotational subluxation, lumbar hypolordosis, and rigidity within the Deformity. Existing classification systems for scoliosis do not encompass the important considerations that are inherent in Deformity in the adult spine. The Adult Spinal Deformity Committee of the Scoliosis Research Society has developed a classification for adult spinal Deformity that is intended to provide an organizational structure for spinal Deformity that permits comparison of similar cases, and provides a framework for an evidence-based approach to the operative and nonoperative management of Deformity in the adult.
