Journal of pediatric orthopedics
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We present a case of an incidental finding of dural ectasia in a child diagnosed with Larsen syndrome. Larsen syndrome is a rare inherited disorder of connective tissue characterized by facial dysmorphism, congenital joint dislocations of the hips, knees and elbows, and deformities of the hands and feet. Dural ectasia is as an abnormal expansion of the dural sac surrounding the spinal cord and may result in spinal morphologic changes, instability, and spontaneous dislocation. To the best of our knowledge, the presence of dural ectasia in Larsen syndrome has not previously been reported. ⋯ Surgeons should be aware of the potential for dural ectasia in patients with Larsen syndrome. Its presence will cause difficulties in the surgical intervention for spinal deformity. Multiple factors must be considered, and surgical approach and technique will require modification to avoid complications. Although dural ectasia confounds surgical intervention in these patients, surgery still appears to outweigh the risks associated with delayed intervention. The presence of dural ectasia should not preclude surgical decompression and stabilization. This report adds to the body of knowledge on the treatment of Larsen syndrome by demonstrating the potential existence of dural ectasia and highlights the importance of careful and thorough preoperative evaluation and diagnostic imaging.
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Comparative Study Clinical Trial
Nighttime bracing versus observation for early adolescent idiopathic scoliosis.
Spinal bracing is widely utilized in patients with moderate severity adolescent idiopathic scoliosis with the goal of preventing curve progression and therefore preventing the need for surgical correction. Bracing is typically initiated in patients with a primary curve angle between 25 and 40 degrees, who are Risser sign 0 to 2 and <1-year postmenarchal. The purpose of this study is to determine whether nighttime bracing using a Charleston bending brace is effective in preventing progression of smaller curves (15 to 25 degrees) in skeletally immature, premenarchal female patients relative to current standard of care (observation for curves <25 degrees). ⋯ Level II--therapeutic study (prospective comparative study).
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Treating progressive early-onset idiopathic scoliosis is challenging. Surgical treatment is indicated in patients whose curves progress despite nonsurgical treatment. Dual growing rod (DGR) technique allows control of the curve while permitting continued spine growth and pulmonary development. Correction in coronal and sagittal planes with this technique has demonstrated both clinically and radiologically in previous studies. It is shown that apical vertebra rotation (AVR) increases with single-rod instrumentation technique. The effect of DGR technique on AVR has not been investigated, yet. The aim of our study was to assess the impact of DGR instrumentation technique on the apical AVR. ⋯ This study proves that the DGR technique has no negative effect on transverse plane deformities. When compared with preoperative values, correction of the AVR during the treatment period suggests that DGR is effective in controlling the coronal and sagittal planes along with transverse plane deformities. Further studies are needed to prove that DGR treatment definitely prevents progression of AVR.
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Although there is good evidence to support the removal of instrumentation for infection following posterior spine fusion, there are few studies that report outcomes following removal for late operative site pain. The purpose of this study was 3-fold: (1) to determine whether removal of instrumentation following posterior spinal fusion resolves preoperative pain, (2) to determine whether indolent infection not detected before removal of instrumentation is related to late operative site pain, and (3) to determine whether curve progression differs when spinal hardware is removed for infection versus late operative site pain. ⋯ Level IV; retrospective case series.
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The quality of the abstracts presented at a conference reflects the scientific work and level of activity of the scientific association concerned. The aim of the present study was to determine the rate of publications of podium presentations and posters at the conferences of the European Paediatric Orthopaedic Society (EPOS) from 2006 to 2008 and to identify factors that favor publication in peer-reviewed journals. The results are compared with those of other international societies. ⋯ Statistical study.