The Experts below are selected from a list of 1374 Experts worldwide ranked by ideXlab platform

Paul D Sponseller - One of the best experts on this subject based on the ideXlab platform.

  • respiratory complications after posterior spinal fusion for Neuromuscular Scoliosis children with rett syndrome at greater risk than those with cerebral palsy
    Spine, 2019
    Co-Authors: Jacob L Cohen, Walter Klyce, Sapna R Kudchadkar, Ronak N Kotian, Paul D Sponseller
    Abstract:

    STUDY DESIGN Retrospective cohort. OBJECTIVE To determine how respiratory failure rates and duration of intensive care unit (ICU) stay after posterior spinal fusion (PSF) for Neuromuscular Scoliosis compare between children with Rett syndrome (RS) versus cerebral palsy (CP). SUMMARY OF BACKGROUND DATA Rett syndrome and CP are associated with high incidence of Neuromuscular Scoliosis and respiratory dysfunction. METHODS We included 21 patients with RS (mean age, 13 ± 3.1 yrs) and 124 with CP (mean age, 14 ± 3.2 yrs) who underwent PSF by one surgeon from 2004 to 2017. Preoperative motor function was assessed using the Gross Motor Function Classification System (GMFCS). Primary outcomes were respiratory failure and duration of ICU stay. Secondary outcomes were pneumonia and prolonged use of positive pressure ventilation (PPV). Using multivariate regression, we identified associations of age, intraoperative vital signs, duration of hospital stay, number of vertebral levels fused, anesthesia and surgery durations, and estimated blood loss with longer ICU stay and respiratory failure. RESULTS A greater proportion of CP patients (96%) than RS patients (66%) were in GMFCS IV or V (P < 0.01). Respiratory failure was more common in RS patients (43% vs. 19%; P = 0.02), as was PPV (67% vs. 31%; P < 0.01). RS patients had shorter median durations of anesthesia and surgery (P < 0.01). RS patients had a longer median (interquartile range) ICU stay (4 days [1-5] vs. 2 days [2-19]; P = 0.01). Incidence of pneumonia did not differ between groups (P = 0.69). Only RS diagnosis (P = 0.02) and prolonged PPV (P < 0.01) were associated with longer ICU stay. CONCLUSION Despite better preoperative motor function and shorter anesthesia and surgery durations, patients with RS experienced more respiratory failure, prolonged PPV use, and longer ICU stays after PSF than did children with CP. LEVEL OF EVIDENCE 4.

  • sacral alar iliac fixation in children with Neuromuscular Scoliosis minimum 5 year follow up
    World Neurosurgery, 2017
    Co-Authors: Amit Jain, Brian T Sullivan, Anne M Kuwabara, Khaled M Kebaish, Paul D Sponseller
    Abstract:

    Objective To investigate the 5-year outcomes of children with Neuromuscular Scoliosis treated with sacral-alar-iliac screws. Methods We reviewed clinical and radiographic records of patients aged ≤18 years treated by 1 pediatric orthopedic surgeon for Neuromuscular Scoliosis with spinal fusion using sacral-alar-iliac pelvic anchors. Thirty-eight patients with a minimum 5-year radiographic follow-up (mean, 6.0 ± 1.2 years) were studied. The mean patient age was 13 ± 2.0 years, and 47% were female. The mean number of levels fused was 18 ± 0.7. Two-thirds (66%) of the patients were diagnosed with cerebral palsy. Results Between the preoperative period and final follow-up, the patients exhibited a mean correction of the major coronal curve of 79% (preoperative, 85° to final, 18°) and a mean 57% correction of the pelvic obliquity (preoperative, 16° to final, 7°). Patients maintained the correction of mean pelvic obliquity from the early postoperative period (6°) to final follow-up (7°). Preoperatively, 76% of the patients had a pelvic obliquity of >10°, compared with 26% of patients postoperatively. There were no cases of neurologic or vascular complications or pseudarthrosis. Radiographs revealed bilateral sacral-alar-iliac screw lucency in 8 patients; 4 of these patients had deep wound infections, and the other 4 were asymptomatic. Unilateral screw fracture was found in 1 patient with an 8-mm-diameter screw (1.3%; 1 of 76 screws); the patient was observed and remained asymptomatic. There were no cases of set screw displacement, screw back-out, or rod dislodgement. Conclusions Sacral-alar-iliac screws are safe and effective pelvic anchors for use in children with Neuromuscular Scoliosis.

  • what s new in the management of Neuromuscular Scoliosis
    Journal of Pediatric Orthopaedics, 2016
    Co-Authors: Jaysson T Brooks, Paul D Sponseller
    Abstract:

    Background:Patients with Neuromuscular Scoliosis (NMS) can pose treatment challenges related to medical comorbidities and altered spinopelvic anatomy. We reviewed the recent literature regarding evaluation and management of NMS patients and explored areas where further research is needed.Methods:We

  • efficacy of multimodality spinal cord monitoring during surgery for Neuromuscular Scoliosis
    Spine, 1995
    Co-Authors: Jeffrey H Owen, Paul D Sponseller, James Szymanski, Mark Hurdle
    Abstract:

    STUDY DESIGN: This study determined the relative efficacy of somatosensory-evoked potentials and motor-evoked potentials in monitoring spinal cord function during surgery for patients with idiopathic versus Neuromuscular Scoliosis. OBJECTIVES: To determine whether patients with idiopathic versus Neuromuscular Scoliosis demonstrate significantly different somatosensory-evoked potentials and motor-evoked potentials recorded during surgery. SUMMARY OF BACKGROUND DATA: Ashkenaze et al (1993) and others have reported that cortical somatosensory-evoked potentials are unreliable when used to monitor spinal cord function in patients with Neuromuscular Scoliosis. It was recommended that other neurophysiologic tests be used. METHODS: Somatosensory-evoked potentials and motor-evoked potentials were recorded from two groups of patients: those with idiopathic Scoliosis and those with Neuromuscular Scoliosis. Somatosensory-evoked potentials were obtained before and during surgery. Motor-evoked potentials were obtained during surgery. Normal variability, as indicated from idiopathic scoliotic results, was compared with data obtained from patients with Neuromuscular Scoliosis. Motor-evoked potentials and somatosensory-evoked potentials were obtained sequentially during the duration of surgery. RESULTS: Single-channel cortical somatosensory-evoked potentials demonstrated a 27% positive rate, which was consistent with results (28%) from Ashkenaze et al. The use of multiple recording sites for the somatosensory-evoked potentials and the addition of motor-evoked potential procedures indicated that a reliable response could be obtained in more than 96% of the patients. It also was found that cortical somatosensory-evoked potentials were more affected by anesthetic agents when recorded from patients with Neuromuscular Scoliosis compared with patients with idiopathic Scoliosis. CONCLUSIONS: Single-channel cortical somatosensory-evoked potentials demonstrated a high level of unreliability, which reduced their clinical effectiveness. However, by using multiple recording sites with the somatosensory-evoked potentials and by administering motor-evoked potential procedures, it was possible to monitor spinal cord function in Neuromuscular patients and avoid postoperative neurologic deficits.

Benny Dahl - One of the best experts on this subject based on the ideXlab platform.

  • increased complications in pediatric patients with non idiopathic Scoliosis undergoing spinal instrumentation for Neuromuscular Scoliosis compared to syndromic and congenital Scoliosis
    Pediatrics, 2020
    Co-Authors: Lorenzo Deveza, John Heydemann, Frank Gerow, William A Phillips, Darrell Hanson, Benny Dahl
    Abstract:

    Purpose: Non-idiopathic Scoliosis encompasses a group of diagnoses including Neuromuscular, syndromic, and congenital Scoliosis. Neuromuscular Scoliosis includes conditions such as cerebral palsy, muscular dystrophy, and spinal muscular atrophy. Syndromic Scoliosis patients are those with Marfan’s Syndrome, Down Syndrome, and DiGeorge Syndrome. Congenital Scoliosis are patients with a congenitally malformed vertebra. It is known that those with Neuromuscular Scoliosis have increased complications in comparison to those with idiopathic Scoliosis. However, patients diagnosed with syndromic …

  • p89 increased complications in pediatric patients with non idiopathic Scoliosis undergoing spinal instrumentation for Neuromuscular Scoliosis compared to syndromic and congenital Scoliosis
    The Spine Journal, 2019
    Co-Authors: Lorenzo Deveza, John Heydemann, Benny Dahl
    Abstract:

    BACKGROUND CONTEXT Non-idiopathic Scoliosis encompasses a group of diagnoses including Neuromuscular, syndromic and congenital Scoliosis. It is known that those with Neuromuscular Scoliosis have increased complications in comparison to those with idiopathic Scoliosis. However, patients diagnosed with syndromic or congenital Scoliosis do not share the same characteristics and are often treated similarly to those with Neuromuscular Scoliosis. The clinical differences between pediatric patients with Neuromuscular Scoliosis and syndromic/congenital Scoliosis are not well described. PURPOSE To assess differences in pediatric non-idiopathic Scoliosis patients with Neuromuscular Scoliosis (NM) vs syndromic and congenital Scoliosis (SS/CS). STUDY DESIGN/SETTING Retrospective cohort study at a single pediatric institution analyzing all cases involving spinal instrumentation for non-idiopathic Scoliosis comparing NM and SS/CS patients. PATIENT SAMPLE All pediatric patients undergoing spinal instrumentation (n=251) for non-idiopathic Scoliosis at a single institution from 2012-2016. OUTCOME MEASURES Intraoperative estimated blood loss by patient weight (ml/kg); Postoperative blood transfusion (ml); mortality at 30 days and 1 year; surgical site infections (SSI); revision surgery and instrument failure in 1 year; readmission in 30 days; return to OR and emergency room visits in 90 days. METHODS This is a retrospective review of all pediatric patients undergoing spinal instrumentation for non-idiopathic Scoliosis. Neuromuscular Scoliosis (NM) patients (n=112 patients, 128 cases) were compared against syndromic and congenital Scoliosis (SS/CS) patients (n=62 patients, 69 cases). Demographics, patient characteristics and outcomes were compared. Variables were analyzed by students' t-test and Categorical variables were analyzed by Chi-Square Test. RESULTS NM patients were older than those with SS/CS (13.3±3.5 NM vs 11.7±3.5 SS/CS, p=0.002). There were no differences in gender and BMI. In terms of pre-existing conditions, there was a higher percentage of NM patients with pulmonary disease (61.2% NM vs 24.3% SS/CS, p CONCLUSIONS Non-idiopathic patients with NM Scoliosis have different patient characteristics and subsequent postoperative complications than those with SS and CS. NM patients are more likely to have pulmonary disease and seizures. Intra-operatively, NM patients have more blood loss. Postoperatively, NM patients have more complications including SSI, readmission and return to OR at 90 days. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Dror Ovadia - One of the best experts on this subject based on the ideXlab platform.

Andrew Jea - One of the best experts on this subject based on the ideXlab platform.

  • the feasibility and safety of using sublaminar polyester bands in hybrid spinal constructs in children and transitional adults for Neuromuscular Scoliosis
    Journal of Neurosurgery, 2015
    Co-Authors: Sohum K Desai, Christina Sayama, Daniel Vener, Alison Brayton, Valentina Briceno, Thomas G Luerssen, Andrew Jea
    Abstract:

    OBJECT The authors have previously reported on their early experience with sublaminar polyester bands in spine surgery. In this paper, the authors describe the use of sublaminar polyester bands in long-segment posterior instrumented spinal fusions from the upper thoracic spine to the ilium in 21 children and transitional adults with progressive Neuromuscular Scoliosis. Transitional adults were patients older than 18 years of age with a spinal disorder of pediatric onset, such as spina bifida. This dedicated study represents the first reported use of polyester bands in spine surgery for Neuromuscular Scoliosis in this patient population in the US. METHODS The authors retrospectively reviewed the demographics and procedural data of patients who underwent posterior instrumented fusion using sublaminar polyester bands for Neuromuscular Scoliosis. RESULTS Twenty-one pediatric and adult transitional patients, ranging in age from 10 to 20 years (mean 14 years), underwent posterior instrumented fusion for progres...

  • iliac screw placement in Neuromuscular Scoliosis using anatomical landmarks and uniplanar anteroposterior fluoroscopic imaging with postoperative ct confirmation
    Journal of Neurosurgery, 2014
    Co-Authors: Loyola V Gressot, Steven W Hwang, Akash J Patel, Daniel H Fulkerson, Andrew Jea
    Abstract:

    Object Neuromuscular Scoliosis is a challenging pathology to treat. Surgical correction can involve long fusion constructs extending to the pelvis. The deformity inherent in these patients makes it difficult to obtain adequate lateral intraoperative radiographs for traditional image-guided placement of iliac screws. Methods A clinical and radiographic assessment of 14 patients with Neuromuscular spinal deformity was conducted. From 2007 to 2013, 12 of these patients (mean age 14.25 years, range 10–20 years) underwent long spinal instrumentation (mean 15 levels, range 10–18 levels) and fusion to the pelvis, and 2 underwent placement of a growing rod construct with iliac screw placement at a single institution. The average length of follow-up was 33.7 months (range 6–64 months). Iliac screws were placed after identifying the posterior superior iliac spine and using only anteroposterior fluoroscopy (view of the inlet of the pelvis), rather than the technique of direct palpation of the sciatic notch. The accu...

Lorenzo Deveza - One of the best experts on this subject based on the ideXlab platform.

  • increased complications in pediatric patients with non idiopathic Scoliosis undergoing spinal instrumentation for Neuromuscular Scoliosis compared to syndromic and congenital Scoliosis
    Pediatrics, 2020
    Co-Authors: Lorenzo Deveza, John Heydemann, Frank Gerow, William A Phillips, Darrell Hanson, Benny Dahl
    Abstract:

    Purpose: Non-idiopathic Scoliosis encompasses a group of diagnoses including Neuromuscular, syndromic, and congenital Scoliosis. Neuromuscular Scoliosis includes conditions such as cerebral palsy, muscular dystrophy, and spinal muscular atrophy. Syndromic Scoliosis patients are those with Marfan’s Syndrome, Down Syndrome, and DiGeorge Syndrome. Congenital Scoliosis are patients with a congenitally malformed vertebra. It is known that those with Neuromuscular Scoliosis have increased complications in comparison to those with idiopathic Scoliosis. However, patients diagnosed with syndromic …

  • p89 increased complications in pediatric patients with non idiopathic Scoliosis undergoing spinal instrumentation for Neuromuscular Scoliosis compared to syndromic and congenital Scoliosis
    The Spine Journal, 2019
    Co-Authors: Lorenzo Deveza, John Heydemann, Benny Dahl
    Abstract:

    BACKGROUND CONTEXT Non-idiopathic Scoliosis encompasses a group of diagnoses including Neuromuscular, syndromic and congenital Scoliosis. It is known that those with Neuromuscular Scoliosis have increased complications in comparison to those with idiopathic Scoliosis. However, patients diagnosed with syndromic or congenital Scoliosis do not share the same characteristics and are often treated similarly to those with Neuromuscular Scoliosis. The clinical differences between pediatric patients with Neuromuscular Scoliosis and syndromic/congenital Scoliosis are not well described. PURPOSE To assess differences in pediatric non-idiopathic Scoliosis patients with Neuromuscular Scoliosis (NM) vs syndromic and congenital Scoliosis (SS/CS). STUDY DESIGN/SETTING Retrospective cohort study at a single pediatric institution analyzing all cases involving spinal instrumentation for non-idiopathic Scoliosis comparing NM and SS/CS patients. PATIENT SAMPLE All pediatric patients undergoing spinal instrumentation (n=251) for non-idiopathic Scoliosis at a single institution from 2012-2016. OUTCOME MEASURES Intraoperative estimated blood loss by patient weight (ml/kg); Postoperative blood transfusion (ml); mortality at 30 days and 1 year; surgical site infections (SSI); revision surgery and instrument failure in 1 year; readmission in 30 days; return to OR and emergency room visits in 90 days. METHODS This is a retrospective review of all pediatric patients undergoing spinal instrumentation for non-idiopathic Scoliosis. Neuromuscular Scoliosis (NM) patients (n=112 patients, 128 cases) were compared against syndromic and congenital Scoliosis (SS/CS) patients (n=62 patients, 69 cases). Demographics, patient characteristics and outcomes were compared. Variables were analyzed by students' t-test and Categorical variables were analyzed by Chi-Square Test. RESULTS NM patients were older than those with SS/CS (13.3±3.5 NM vs 11.7±3.5 SS/CS, p=0.002). There were no differences in gender and BMI. In terms of pre-existing conditions, there was a higher percentage of NM patients with pulmonary disease (61.2% NM vs 24.3% SS/CS, p CONCLUSIONS Non-idiopathic patients with NM Scoliosis have different patient characteristics and subsequent postoperative complications than those with SS and CS. NM patients are more likely to have pulmonary disease and seizures. Intra-operatively, NM patients have more blood loss. Postoperatively, NM patients have more complications including SSI, readmission and return to OR at 90 days. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.