The spine journal : official journal of the North American Spine Society
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The efficacy of one-stage posterior pedicle screw instrument used in the treatment of non-dystrophic scoliosis in neurofibromatosis type I (NF-1) is unknown. Also, there is no study that has directly compared the results of spinal deformity correction between non-dystrophic scoliosis in NF-1 and adolescent idiopathic scoliosis (AIS). ⋯ Despite the differences in preoperative flexibilities and fusion strategies, non-dystrophic scoliosis in NF-1 can be treated with a satisfied correction rate and progression rate similar to comparable AIS by using the one-stage posterior pedicle screw technique. Dural ectasia or thin pedicles in non-dystrophic scoliosis could make pedicle screw placement challenging.
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Posterior three-column spinal osteotomies were shown to be effective to treat severe and stiff kyphoscoliosis. Translations at the site of osteotomy after deformity correction were commonly seen intraoperatively, which might cause potential neurologic deficits. However, this phenomenon was not thoroughly discussed in the current literature. ⋯ The 3D translations are common in posterior three-column spinal osteotomies regardless of anterior strut graft placement. The increase of translation will increase neurologic risks, with GT or FT less than grade II and ST less than grade I being relatively safe.
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Facet tropism is defined as the angular difference between the left and the right facet orientation. Facet tropism was suggested to be associated with the disc degeneration and facet degeneration in the lumbar spine. However, little is known about the relationship between facet tropism and pathologic changes in the cervical spine and the mechanism behind. ⋯ Facet tropism with respect to the sagittal plane at the C5-C6 level increased the IDP and facet contact force under flexion, extension, lateral bending, and axial rotation. The results suggested that facet tropism might be the anatomic risk factor of the development of cervical disc degeneration or facet degeneration. Future clinical studies are in need to verify the biomechanical impact of facet tropism on the development of degenerative changes in the cervical spine.
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The Accreditation Council for Graduate Medical Education (ACGME) guidelines requires residency programs to teach and evaluate residents in six overarching "core competencies" and document progress through educational milestones. To assess the progress of orthopedic interns' skills in performing a history, physical examination, and documentation of the encounter for a standardized patient with spinal stenosis, an objective structured clinical examination (OSCE) was conducted for 13 orthopedic intern residents, following a 1-month boot camp that included communications skills and curriculum in history and physical examination. Interns were objectively scored based on their performance of the physical examination, communication skills, completeness and accuracy of their electronic medical record (EMR), and their diagnostic conclusions gleaned from the patient encounter. ⋯ The results of this study highlighted significant shortcomings in the completeness of the interns' spine history and physical examination, and the accuracy and completeness oftheir EMR note. The study provides a valuable exercise for evaluating residents in a multifaceted, multi-milestone manner that more accurately documents residents' clinical strengths and weaknesses. The study demonstrates that orthopedic residents require further instruction on the complexities of the spinal examination. It validates a need for increased systemic support for improving resident documentation through comprehensive education and evaluation modules.
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Surgical treatment of lumbar disc herniation (LDH) may lead to different outcomes in young, middle-aged, and elderly patients. However, no study has, by the same data ascertainment, evaluated referral pattern, improvement, and outcome in different age strata. ⋯ In general, older patients referred to LDH surgery have statistically significantly inferior PROM scores, improve less, and reach inferior PROM scores postoperatively. The clinical relevance must however be questioned because most patients reach, independent of age group, the defined level for a successful outcome, and the patient satisfaction rate is high.