The spine journal : official journal of the North American Spine Society
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Lateral distraction injuries represent a very rare pattern of injury with only five cases reported in the literature. Such injuries are a result of high-energy trauma and have a high association with severe concomitant injuries. All previous reports of this injury are in skeletally mature individuals, and this has not been previously described in young children. ⋯ In this case, we describe a lateral distraction injury in a young child secondary to improper seat belt use. This represents the first description of such an injury in this age group, and this case highlights the spectrum of injury caused by improper seat belt use in the pediatric population.
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Pedicle screws have shown to be a safe and effective method of spinal fixation, offering superior multiplanar correction compared with hooks or sublaminar wires in selected situations. Though only food and drug administration (FDA) approved in the adolescent population, they are commonly used in an off-label manner in the preadolescent population. ⋯ The complication rates in the young pediatric population associated with the off-label use of pedicle screws for spinal fusions are not statistically different from the complication rates associated with the FDA-approved adolescent population.
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Knowledge of sagittal spinopelvic parameters is important for the treatment of cerebral palsy (CP) because they differ in the normal population and can induce symptoms. ⋯ A significant difference was observed in the sagittal spinopelvic parameters in the CP and normal control groups and was possibly related to the symptoms. The study shows that the evaluations of sagittal spinopelvic parameters could be useful during the treatment of disorders associated with CP.
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There is currently no reliable technique for intraoperative assessment of pedicle screw fixation strength and optimal screw size. Several studies have evaluated pedicle screw insertional torque (IT) and its direct correlation with pullout strength. However, there is limited clinical application with pedicle screw IT as it must be measured during screw placement and rarely causes the spine surgeon to change screw size. To date, no study has evaluated tapping IT, which precedes screw insertion, and its ability to predict pedicle screw pullout strength. ⋯ Our findings suggest that tapping IT directly correlates with pedicle screw IT, pedicle screw pullout strength, and optimal pedicle screw size. Therefore, tapping IT may be used during thoracic pedicle screw instrumentation as an adjunct to preoperative imaging and clinical experience to maximize fixation strength and optimize pedicle "fit and fill" with the largest screw possible. However, further prospective, in vivo studies are necessary to evaluate the intraoperative use of tapping IT to predict screw loosening/complications.