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Michael P. Glotzbecker - One of the best experts on this subject based on the ideXlab platform.
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Is there a relationship between thoracic dimensions and pulmonary function in early-onset scoliosis?
Spine, 2014Co-Authors: Michael P. Glotzbecker, Meryl Gold, Patricia E. Miller, Charles E. Johnston, John T. Smith, Francisco Sanchez Perez-grueso, Regina P. Woon, John M. Flynn, Sumeet Garg, Gregory J. ReddingAbstract:STUDY DESIGN Cross-sectional retrospective analysis. OBJECTIVE To examine the degree of correlation between thoracic dimension outcome measures and pulmonary function in early-onset scoliosis (EOS). SUMMARY OF BACKGROUND DATA Change in thoracic dimension (TD) measurements and spine length are commonly reported outcome measures after treatment for EOS. Although ultimately improving or maintaining pulmonary function is the goal of EOS treatment strategies, it is unclear whether commonly reported 2-dimensional TD measurements represent good predictors of pulmonary function. METHODS A cross-sectional analysis of patients including all diagnoses obtained from 2 EOS databases containing TD measurements and pulmonary function data was performed. Relationships between individual TD measurements and pulmonary function measurements were assessed using the Pearson correlation analysis. TD measurements (Pelvic Inlet width, T1-T12 height, T1-S1 height, and coronal chest width) and standard pulmonary function measurements were compared. TD percentiles normalized for Pelvic Inlet width were also calculated and correlated with pulmonary function measurement percentiles. Univariate and multivariate linear regression analyses determined whether TD measurements could predict pulmonary function. RESULTS There were 121 patients (65 females, 56 males) in the study. Mean age at evaluation was 9.3 years (range, 2.7-18.1 yr). T1-T12 height, T1-S1 height, maximal chest width, and Pelvic Inlet width were all significantly correlated with forced air volume expelled in 1 second, total forced air volume, and total lung capacity (correlation coefficients [r] 0.33-0.61; all P
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Distraction-based treatment maintains predicted thoracic dimensions in early-onset scoliosis
Spine deformity, 2014Co-Authors: Michael P. Glotzbecker, Meryl Gold, Charles E. Johnston, Patrica Miller, Behrooz A. Akbarnia, Suken A. Shah, Francisco Sanchez Perez Grueso, John B. EmansAbstract:Abstract Study Design Retrospective cohort study. Objective Examination of distraction-based treatment effect on thoracic dimensions in patients compared to predicted individual normal values, at initial treatment and subsequent follow-up after lengthenings. Summary of Background Data Change in thoracic dimensions and spine length is an important outcome measure in treatment of children with early-onset scoliosis; however, it is difficult to use to make comparisons between patients and the normal population because of the heterogeneous nature of early-onset scoliosis. Methods Early-onset scoliosis patients treated with distraction-based therapy who had radiographic parameters (Pelvic Inlet width, chest width, and thoracic height) preoperatively, immediately postoperatively, and at a minimum 5-year follow-up were included. Individual thoracic measurements were compared with predicted normal measures based on Pelvic Inlet width, and expressed as a percentile of predicted measure. Results Comparisons were made in 41 patients; mean age at time of primary surgery was 4.5 years, and median follow-up was 6.5 years. Thoracic height percentile increased from a mean preoperative value of .78 to a postoperative percentile of .88 (p Conclusions Distraction-based treatment increases absolute thoracic height over time. There is significant improvement in the thoracic height percentile normalized after initial surgery, which was maintained over time. Measuring expected gains as a percentile normalized for Pelvic width may be a more relevant outcome measure compared with measuring only absolute values.
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Distraction-Based Treatment Maintains Predicted Thoracic Dimensions in Early-Onset Scoliosis
Spine Deformity, 2014Co-Authors: Michael P. Glotzbecker, Meryl Gold, Francisco Sanchez Perez-grueso, Patrica Miller, Behrooz A. Akbarnia, Charles Johnston, Suken A. Shah, John EmansAbstract:Study Design Retrospective cohort study. Objective Examination of distraction-based treatment effect on thoracic dimensions in patients compared to predicted individual normal values, at initial treatment and subsequent follow-up after lengthenings. Summary of Background Data Change in thoracic dimensions and spine length is an important outcome measure in treatment of children with early-onset scoliosis; however, it is difficult to use to make comparisons between patients and the normal population because of the heterogeneous nature of early-onset scoliosis. Methods Early-onset scoliosis patients treated with distraction-based therapy who had radiographic parameters (Pelvic Inlet width, chest width, and thoracic height) preoperatively, immediately postoperatively, and at a minimum 5-year follow-up were included. Individual thoracic measurements were compared with predicted normal measures based on Pelvic Inlet width, and expressed as a percentile of predicted measure. Results Comparisons were made in 41 patients; mean age at time of primary surgery was 4.5 years, and median follow-up was 6.5 years. Thoracic height percentile increased from a mean preoperative value of.78 to a postoperative percentile of.88 (p
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Prediction of thoracic dimensions and spine length on the basis of individual Pelvic dimensions: validation of the use of Pelvic Inlet width obtained by radiographs compared with computed tomography.
Spine, 2014Co-Authors: Meryl Gold, Michael F. Dombek, Patricia E. Miller, John B. Emans, Michael P. GlotzbeckerAbstract:STUDY DESIGN Retrospective review. OBJECTIVE To validate the Pelvic Inlet width (PIW) measurement obtained on radiograph as an independent standard used to correlate with thoracic dimensions (TDs) in treated and untreated patients with early-onset scoliosis. SUMMARY OF BACKGROUND DATA In children with early-onset scoliosis, the change in TD and spine length is a key treatment goal. Quantifying this change is confounded by varied growth rates and differing diagnoses. PIW measured on computed tomographic (CT) scan in patients without scoliosis has been shown to correlate with TD in an age-independent manner. METHODS The first arm included 49 patients with scoliosis who had both a CT scan and Pelvic radiograph. Agreement between PIW measurements on CT scan and radiograph was analyzed. The second arm consisted of 163 patients (age, 0.2-18.7 yr), with minimal spinal deformity (mean Cobb, 9.0°) and radiographs in which PIW was measurable. PIW was compared with previously published CT-based TD measurements; maximal chest width, T1-T12 height, and T1-S1 height. Linear regression analysis was used to develop and validate sex-specific predictive equations for each TD measurement on the basis of PIW. Interobserver reliability was evaluated for all measurements. RESULTS Bland-Altman analysis indicated agreement with no dependence on observed value, but a consistent 8.5 mm (95% CI: 7.2-9.9 mm) difference in CT scan measurement compared with radiographical PIW measurement. Sex and PIW were significantly correlated to each TD measurement (P < 0.01). Predictive models were validated and may be used to estimate TD measurements on the basis of sex and radiographical PIW. Intraclass correlation coefficients for all measurements were between 0.978 and 0.997. CONCLUSION PIW on radiographs and CT scan correlate in patients with deformity and with spine and TD in patients with minimal deformity. It is a fast, reliable method of assessing growth while lowering patient's radiation exposure. It can be reliably used to assess patients with early-onset scoliosis and the impact surgical treatment has on chest and spinal growth. LEVEL OF EVIDENCE 3.
W. R. Schouten - One of the best experts on this subject based on the ideXlab platform.
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enterocele repair by abdominal obliteration of the Pelvic Inlet long term outcome on obstructed defaecation and symptoms of Pelvic discomfort
Colorectal Disease, 2007Co-Authors: D. M. J. Oom, M. J. Gosselink, V. R. M. Van Dijl, J. J. Van Wijk, W. R. SchoutenAbstract:Objective Enterocele is defined as a herniation of the peritoneal sac between the vagina and the rectum. This may contain either sigmoid colon or small bowel. It has been reported that enterocele is associated with obstructed defaecation and symptoms of Pelvic discomfort. The aim of the present study was to evaluate the long-term effect of enterocele repair. Method In the time period between 1994 and 2003, 54 women (median age 54 years; range: 31–80) with a symptomatic enterocele underwent obliteration of the Pelvic Inlet with a U-shaped Mersilene® mesh. All patients underwent evacuation proctography (EP), which was repeated 6 months after the repair. In addition, they were contacted over the telephone to assess the long-term effect of enterocele repair. Forty-nine patients were willing to answer questions over the telephone. Five patients were lost to follow-up (response rate: 91%). Results Six months after the procedure, EP revealed a recurrent or persistent enterocele in five (9%) patients, which was symptomatic in two, both of whom underwent a second repair. Among the 49 patients without an enterocele after 6 months, 10 (23%) women encountered recurrent symptoms of Pelvic discomfort at a median follow-up of 85 months (range: 3–137). Despite adequate correction of the enterocele, obstructed defaecation persisted in 21 (75%) patients of 28, who presented with this problem before the procedure. De novo dyspareunia occurred in 5% of the women after the procedure. Conclusion Obliteration of the Pelvic Inlet with a U-shaped Mersilene® mesh provides an effective tool for anatomical correction of enteroceles. However, in the long term one of four patients encounters recurrent symptoms of Pelvic discomfort. It seems unlikely that enterocele contributes to obstructed defaecation, as evacuation difficulties persist in around three quarters of the patients.
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Enterocele repair by abdominal obliteration of the Pelvic Inlet: long‐term outcome on obstructed defaecation and symptoms of Pelvic discomfort
Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland, 2007Co-Authors: D. M. J. Oom, M. J. Gosselink, V. R. M. Van Dijl, J. J. Van Wijk, W. R. SchoutenAbstract:Objective Enterocele is defined as a herniation of the peritoneal sac between the vagina and the rectum. This may contain either sigmoid colon or small bowel. It has been reported that enterocele is associated with obstructed defaecation and symptoms of Pelvic discomfort. The aim of the present study was to evaluate the long-term effect of enterocele repair. Method In the time period between 1994 and 2003, 54 women (median age 54 years; range: 31–80) with a symptomatic enterocele underwent obliteration of the Pelvic Inlet with a U-shaped Mersilene® mesh. All patients underwent evacuation proctography (EP), which was repeated 6 months after the repair. In addition, they were contacted over the telephone to assess the long-term effect of enterocele repair. Forty-nine patients were willing to answer questions over the telephone. Five patients were lost to follow-up (response rate: 91%). Results Six months after the procedure, EP revealed a recurrent or persistent enterocele in five (9%) patients, which was symptomatic in two, both of whom underwent a second repair. Among the 49 patients without an enterocele after 6 months, 10 (23%) women encountered recurrent symptoms of Pelvic discomfort at a median follow-up of 85 months (range: 3–137). Despite adequate correction of the enterocele, obstructed defaecation persisted in 21 (75%) patients of 28, who presented with this problem before the procedure. De novo dyspareunia occurred in 5% of the women after the procedure. Conclusion Obliteration of the Pelvic Inlet with a U-shaped Mersilene® mesh provides an effective tool for anatomical correction of enteroceles. However, in the long term one of four patients encounters recurrent symptoms of Pelvic discomfort. It seems unlikely that enterocele contributes to obstructed defaecation, as evacuation difficulties persist in around three quarters of the patients.
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Treatment of enterocele by obliteration of the Pelvic Inlet.
Diseases of the colon and rectum, 1999Co-Authors: M. J. Gosselink, J. H. Van Dam, W. M. Huisman, A. Z. Ginai, W. R. SchoutenAbstract:PURPOSE: Enterocele is defined as a herniation of the peritoneal sac between the vagina and the rectum. This hernial sac contains either sigmoid colon or small bowel. It is well known that enteroceles are associated with symptoms of Pelvic discomfort. It is unclear whether enteroceles contribute to evacuation difficulties. Controversies also exist regarding their treatment of choice. The aim of the present prospective study was to evaluate the impact of obliteration of the Pelvic Inlet on evacuation difficulties and on symptoms of Pelvic discomfort. METHODS: From October 1994 to August 1996 20 females (median age, 53; range, 41–73 years) with symptomatic enterocele diagnosed on evacuation proctography underwent obliteration of the Pelvic Inlet with a nonabsorbable Mersilene® mesh. All patients presented with Pelvic discomfort, characterized by feelings of prolapse (n=20), Pelvic pressure (n=16), lower abdominal pain (n=13), and false urge to defecate (n=15). Symptoms of obstructed defecation were noted in 15 patients. Six months after repair, evacuation proctography with opacification of the small bowel and the vagina was repeated. RESULTS: The median duration of follow-up was 25 (range, 10–34) months. A persistent or recurrent enterocele was observed in none of the patients. All symptoms of Pelvic discomfort disappeared except feelings of a false urge to defectate, which persisted in 27 percent of cases. Symptoms of obstructed defecation persisted in all patients with evacuation difficulties. CONCLUSIONS: In patients with Pelvic discomfort enterocele should be considered as a possible causative factor. It is unlikely that this abnormality contributes to the problem of obstructed defecation. In patients with a symptomatic enterocele, obliteration of the Pelvic Inlet with a Mersilene® mesh is an adequate treatment.
Robert B. Gherman - One of the best experts on this subject based on the ideXlab platform.
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shoulder dystocia management and documentation
Seminars in Perinatology, 2014Co-Authors: Michael L Stitely, Robert B. GhermanAbstract:Shoulder dystocia is an obstetric emergency that occurs when the fetal shoulders become impacted at the Pelvic Inlet. Management is based on performing maneuvers to alleviate this impaction. A number of protocols and training mnemonics have been developed to assist in managing shoulder dystocia when it occurs. This article reviews the evidence regarding the performance, timing, and sequence of these maneuvers; reviews the mechanism of fetal injury in relation to shoulder dystocia; and discusses issues concerning documentation of the care provided during this obstetric emergency.
Meryl Gold - One of the best experts on this subject based on the ideXlab platform.
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Is there a relationship between thoracic dimensions and pulmonary function in early-onset scoliosis?
Spine, 2014Co-Authors: Michael P. Glotzbecker, Meryl Gold, Patricia E. Miller, Charles E. Johnston, John T. Smith, Francisco Sanchez Perez-grueso, Regina P. Woon, John M. Flynn, Sumeet Garg, Gregory J. ReddingAbstract:STUDY DESIGN Cross-sectional retrospective analysis. OBJECTIVE To examine the degree of correlation between thoracic dimension outcome measures and pulmonary function in early-onset scoliosis (EOS). SUMMARY OF BACKGROUND DATA Change in thoracic dimension (TD) measurements and spine length are commonly reported outcome measures after treatment for EOS. Although ultimately improving or maintaining pulmonary function is the goal of EOS treatment strategies, it is unclear whether commonly reported 2-dimensional TD measurements represent good predictors of pulmonary function. METHODS A cross-sectional analysis of patients including all diagnoses obtained from 2 EOS databases containing TD measurements and pulmonary function data was performed. Relationships between individual TD measurements and pulmonary function measurements were assessed using the Pearson correlation analysis. TD measurements (Pelvic Inlet width, T1-T12 height, T1-S1 height, and coronal chest width) and standard pulmonary function measurements were compared. TD percentiles normalized for Pelvic Inlet width were also calculated and correlated with pulmonary function measurement percentiles. Univariate and multivariate linear regression analyses determined whether TD measurements could predict pulmonary function. RESULTS There were 121 patients (65 females, 56 males) in the study. Mean age at evaluation was 9.3 years (range, 2.7-18.1 yr). T1-T12 height, T1-S1 height, maximal chest width, and Pelvic Inlet width were all significantly correlated with forced air volume expelled in 1 second, total forced air volume, and total lung capacity (correlation coefficients [r] 0.33-0.61; all P
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Distraction-based treatment maintains predicted thoracic dimensions in early-onset scoliosis
Spine deformity, 2014Co-Authors: Michael P. Glotzbecker, Meryl Gold, Charles E. Johnston, Patrica Miller, Behrooz A. Akbarnia, Suken A. Shah, Francisco Sanchez Perez Grueso, John B. EmansAbstract:Abstract Study Design Retrospective cohort study. Objective Examination of distraction-based treatment effect on thoracic dimensions in patients compared to predicted individual normal values, at initial treatment and subsequent follow-up after lengthenings. Summary of Background Data Change in thoracic dimensions and spine length is an important outcome measure in treatment of children with early-onset scoliosis; however, it is difficult to use to make comparisons between patients and the normal population because of the heterogeneous nature of early-onset scoliosis. Methods Early-onset scoliosis patients treated with distraction-based therapy who had radiographic parameters (Pelvic Inlet width, chest width, and thoracic height) preoperatively, immediately postoperatively, and at a minimum 5-year follow-up were included. Individual thoracic measurements were compared with predicted normal measures based on Pelvic Inlet width, and expressed as a percentile of predicted measure. Results Comparisons were made in 41 patients; mean age at time of primary surgery was 4.5 years, and median follow-up was 6.5 years. Thoracic height percentile increased from a mean preoperative value of .78 to a postoperative percentile of .88 (p Conclusions Distraction-based treatment increases absolute thoracic height over time. There is significant improvement in the thoracic height percentile normalized after initial surgery, which was maintained over time. Measuring expected gains as a percentile normalized for Pelvic width may be a more relevant outcome measure compared with measuring only absolute values.
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Distraction-Based Treatment Maintains Predicted Thoracic Dimensions in Early-Onset Scoliosis
Spine Deformity, 2014Co-Authors: Michael P. Glotzbecker, Meryl Gold, Francisco Sanchez Perez-grueso, Patrica Miller, Behrooz A. Akbarnia, Charles Johnston, Suken A. Shah, John EmansAbstract:Study Design Retrospective cohort study. Objective Examination of distraction-based treatment effect on thoracic dimensions in patients compared to predicted individual normal values, at initial treatment and subsequent follow-up after lengthenings. Summary of Background Data Change in thoracic dimensions and spine length is an important outcome measure in treatment of children with early-onset scoliosis; however, it is difficult to use to make comparisons between patients and the normal population because of the heterogeneous nature of early-onset scoliosis. Methods Early-onset scoliosis patients treated with distraction-based therapy who had radiographic parameters (Pelvic Inlet width, chest width, and thoracic height) preoperatively, immediately postoperatively, and at a minimum 5-year follow-up were included. Individual thoracic measurements were compared with predicted normal measures based on Pelvic Inlet width, and expressed as a percentile of predicted measure. Results Comparisons were made in 41 patients; mean age at time of primary surgery was 4.5 years, and median follow-up was 6.5 years. Thoracic height percentile increased from a mean preoperative value of.78 to a postoperative percentile of.88 (p
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Prediction of thoracic dimensions and spine length on the basis of individual Pelvic dimensions: validation of the use of Pelvic Inlet width obtained by radiographs compared with computed tomography.
Spine, 2014Co-Authors: Meryl Gold, Michael F. Dombek, Patricia E. Miller, John B. Emans, Michael P. GlotzbeckerAbstract:STUDY DESIGN Retrospective review. OBJECTIVE To validate the Pelvic Inlet width (PIW) measurement obtained on radiograph as an independent standard used to correlate with thoracic dimensions (TDs) in treated and untreated patients with early-onset scoliosis. SUMMARY OF BACKGROUND DATA In children with early-onset scoliosis, the change in TD and spine length is a key treatment goal. Quantifying this change is confounded by varied growth rates and differing diagnoses. PIW measured on computed tomographic (CT) scan in patients without scoliosis has been shown to correlate with TD in an age-independent manner. METHODS The first arm included 49 patients with scoliosis who had both a CT scan and Pelvic radiograph. Agreement between PIW measurements on CT scan and radiograph was analyzed. The second arm consisted of 163 patients (age, 0.2-18.7 yr), with minimal spinal deformity (mean Cobb, 9.0°) and radiographs in which PIW was measurable. PIW was compared with previously published CT-based TD measurements; maximal chest width, T1-T12 height, and T1-S1 height. Linear regression analysis was used to develop and validate sex-specific predictive equations for each TD measurement on the basis of PIW. Interobserver reliability was evaluated for all measurements. RESULTS Bland-Altman analysis indicated agreement with no dependence on observed value, but a consistent 8.5 mm (95% CI: 7.2-9.9 mm) difference in CT scan measurement compared with radiographical PIW measurement. Sex and PIW were significantly correlated to each TD measurement (P < 0.01). Predictive models were validated and may be used to estimate TD measurements on the basis of sex and radiographical PIW. Intraclass correlation coefficients for all measurements were between 0.978 and 0.997. CONCLUSION PIW on radiographs and CT scan correlate in patients with deformity and with spine and TD in patients with minimal deformity. It is a fast, reliable method of assessing growth while lowering patient's radiation exposure. It can be reliably used to assess patients with early-onset scoliosis and the impact surgical treatment has on chest and spinal growth. LEVEL OF EVIDENCE 3.
Joshua Heller - One of the best experts on this subject based on the ideXlab platform.
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fluoroscopic confirmation of sacral pedicle screw placement utilizing Pelvic Inlet and outlet technique technical note
Journal of Spinal Disorders & Techniques, 2017Co-Authors: George M Ghobrial, Fadi Alsaiegh, Daniel Franco, Joshua HellerAbstract:Minimally invasive surgical techniques may decrease length of stay, operative duration and blood loss, and postoperative pain. Numerous technical challenges and concerns surround the placement of percutaneous pedicle screws at the lumbosacral level. Maximization of screw triangulation, bicortical purchase, and rostral bias toward the sacral promontory has been shown repeatedly to stabilize lumbosacral segment instrumentation and maximize pullout strength. Because of the unique anatomy, conventional anteroposterior (AP) and lateral radiographic views are relatively less reliable at determining screw depth and penetration of the sacral cortex. Percutaneous sacral pedicle fixation using AP and lateral 2-dimensional fluoroscopy is complicated by the variable contour of the sacral alae and promontory. The Pelvic Inlet view is ideal for visualization of the ventral screw extent and is obtained by directing 45-degree cephalad and 0-degree mediolateral, with adjustments aligning the patient's Pelvic brim. The modified Pelvic outlet view is obtained with the trajectory axis being directed 45-degree caudal from the AP plane. This aligns the pubic symphysis with the second sacral vertebrae providing visualization of the superior boundary of the S1-bony neural foramen and any inferior wall pedicle breaches. The authors describe this reliable fluoroscopic technique and their clinical experience with percutaneous S1-screw placement.