Area Deprivation Index and Magnitude of Scoliosis at Presentation to a Tertiary Referral Scoliosis Clinic in Massachusetts.

BACKGROUND: There is growing interest in identifying predictors of large scoliosis curves at initial presentation, but few data to guide such preventive efforts. The association of neighborhood socioeconomic deprivation with curve magnitude in this context has not been previously evaluated. The purpose of our study was to determine the correlation of socioeconomic deprivation with scoliosis curve magnitude at initial presentation. Secondarily, we assessed the correlation of body mass index (BMI) with curve severity. METHODS: We retrospectively identified 202 patients presenting with adolescent idiopathic scoliosis to a single tertiary care center in Massachusetts from January 2015 to August 2018. The Area Deprivation Index (ADI), a validated composite measure of neighborhood socioeconomic deprivation, was calculated for each patient. Curve magnitude, age, sex, BMI, race, and insurance status were recorded. Pearson correlation was used to determine the association of the ADI and BMI with scoliosis severity. RESULTS: There was no correlation between the ADI and the magnitude of scoliosis at presentation (r=0.055; P=0.43). Greater BMI was moderately correlated with increased scoliosis curve magnitude (r=0.28; P<0.001). There was no association between curve magnitude and patient age, sex, race, or insurance status. CONCLUSIONS: The finding that neighborhood socioeconomic deprivation did not correlate with greater scoliosis severity at presentation may be suggestive of equitable access to specialized scoliosis care. Future research should determine whether this reassuring finding is unique to Massachusetts--a state with high rates of health insurance coverage--or generalizable to other US states. In addition, our study further corroborates the notion that greater BMI is associated with larger scoliosis curves, and calls for targeted interventions to facilitate early scoliosis detection in the growing childhood obese population. LEVEL OF EVIDENCE: Level II-prognostic study and retrospective study.

Posterior Spinal Fusion for Scoliosis in the Oldest Reported Patient with Crane-Heise Syndrome: A Case Report.

CASE: A 14-year-old adolescent girl with Crane-Heise syndrome-the oldest such patient in the literature-presented to our clinic with progressive scoliosis, including a 90° T6-L3 apex right curve. She underwent a T3-pelvis posterior spinal fusion. Intraoperatively, she had small, poorly visualized upper thoracic pedicles, incomplete fusion of the posterior spinal elements, and limitations of intraoperative neuromonitoring. Adherence to dysplastic scoliosis principles allowed for an uncomplicated procedure with an excellent correction. CONCLUSION: We discuss the surgical management of scoliosis in an adolescent with Crane-Heise syndrome. This is a very rare skeletal dysplasia, with 9 reported cases in the literature.

Unilateral hip reconstruction in children with cerebral palsy: predictors for failure.

BACKGROUND: Unilateral hip reconstruction in patients with cerebral palsy can be complicated by contralateral subluxation and ipsilateral failure. We sought to identify predictors for failure after unilateral reconstruction in patients with GMFCS IV-V CP with unilateral hip involvement. METHODS: We performed an IRB-approved retrospective study on GMFCS IV-V CP patients with unilateral hip reconstruction at a minimum 2-year follow-up. Radiologic data included acetabular index, femoral migration index (FMI), lateral center edge angle (LCE), and pelvic obliquity. The effects of age, sex, pelvic obliquity, scoliosis surgery, and contralateral hip soft-tissue release at the index surgery were analyzed for ipsilateral hip failure and contralateral hip subluxation. Statistical analysis was performed using the χ and t tests. RESULTS: There were 35 patients (M:F, 23:12) with mean age of 110 months (range, 45 to 215 mo) with mean follow-up of 60.5 months (range, 24 to 129 mo). The mean preoperative ipsilateral hip FMI was 60% (range, 40% to 100%) and the mean LCE was -16.7 degrees (range, -85 to 17.2 degrees). Contralateral soft-tissue release was performed in 13/35 patients. Ipsilateral hip failure or contralateral hip subluxation was observed in 51% (18/35) patients. Contralateral hip subluxation developed in 28% (10/35) of patients. Ipsilateral hip failure was observed in 34% (12/35) patients. Four had both ipsilateral failure and contralateral subluxation. Lack of contralateral hip soft-tissue release, reversal of pelvic obliquity angle, and high initial contralateral hip FMI (> 25%) significantly predicted the risk of contralateral hip subluxation (P = 0.03). Similarly, persistence or worsening of preoperative pelvic obliquity significantly predicted ipsilateral hip failure (P < 0.04). There was a strong trend toward contralateral hip subluxation in patients below 8 years of age (P = 0.1) and ipsilateral hip failure in those who had spinal fusion surgery for scoliosis (P = 0.06). CONCLUSIONS: Predictors of contralateral hip subluxation included lack of contralateral soft-tissue release, reversal of pelvic obliquity angle, and larger initial contralateral hip FMI (> 25%). The only predictor of ipsilateral failure was persistence or worsening of preoperative pelvic obliquity.

The treatment of pediatric supracondylar humerus fractures.

Based on the best current evidence and a systematic review of published studies, 14 recommendations have been created to guide clinical practice and management of supracondylar fractures of the humerus in children. Two each of these recommendations are graded Weak and Consensus; eight are graded Inconclusive. The two Moderate recommendations include nonsurgical immobilization for acute or nondisplaced fractures of the humerus or posterior fat pad sign, and closed reduction with pin fixation for displaced type II and III and displaced flexion fractures.

Superior mesenteric artery syndrome following spinal deformity correction.

BACKGROUND: Superior mesenteric artery syndrome is a known complication associated with the correction of spinal deformity. Recent investigations of this disorder have focused on patient height and weight. We are not aware of any published study examining the degree of deformity, type of curve, or magnitude of correction, and to our knowledge all of the reported literature on this syndrome lacks control data. The purpose of this study was to examine the relationship between the correction of spinal deformity and the development of superior mesenteric artery syndrome in patients with scoliosis. Our hypothesis was that greater correction of spinal deformity would increase the risk of the development of superior mesenteric artery syndrome. METHODS: A case-control study was performed over a five-year period. The primary outcome measure was the development of superior mesenteric artery syndrome. The predictor variables that were considered included demographic characteristics; preoperative height, weight, and body mass index; aspects of the deformity, including curve magnitude, Lenke curve classification, and correction; and operative factors, including surgical approach, estimated blood loss, and the presence of operative hypotension. RESULTS: A review of the records on 364 surgical procedures for scoliosis identified seventeen cases of superior mesenteric artery syndrome. Thirty-four subjects who had had surgery for scoliosis but no superior mesenteric artery syndrome were randomly selected as controls. Eight of the seventeen subjects with superior mesenteric artery syndrome had undergone a two-stage procedure (compared with one of the thirty-four controls, p < 0.001), nine of the seventeen had had combined anterior and posterior procedures (compared with two of the thirty-four controls, p < 0.001), and seven of the seventeen had had a thoracoplasty (compared with two of the thirty-four controls, p < 0.001). No significant differences were noted between the groups with regard to demographic factors. Compared with the controls, the patients in whom superior mesenteric artery syndrome developed were shorter (by a mean of 7.1 cm, p = 0.03), weighed less (by a mean of 11.5 kg, p = 0.001), had a lower body mass index (p = 0.003), had a greater minimal thoracic curve magnitude achieved by bending (a mean of 12 degrees greater [45 degrees for subjects with superior mesenteric artery syndrome and 33 degrees for controls], p = 0.015), had a lower percent correction of the thoracic curve on bending (a mean of 11% lower, p = 0.025), and had more lumbar lateralization (88%, compared with 61% in the control group, had a Lenke lumbar modifier of B or C instead of A, p = 0.008). Multivariate logistic regression analysis identified a staged procedure (odds ratio, 31.0), the lumbar modifier (odds ratio, 9.06), body mass index (odds ratio, 7.75), and thoracic stiffness (odds ratio, 6.67) as the most predictive of the development of superior mesenteric artery syndrome. CONCLUSIONS: Preoperative identification of the risk factors described above in conjunction with preoperative nutritional maximization should be considered in order to limit the prevalence of superior mesenteric artery syndrome in patients undergoing surgical correction of spinal deformity.

The relationship between menstrual cycle phase and anterior cruciate ligament injury: a case-control study of recreational alpine skiers.

BACKGROUND: Female athletes suffer a greater incidence of anterior cruciate ligament tears compared with male athletes when participating in common sports; however, very little is known about the factors that explain this disparity. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: Female recreational alpine skiers with an anterior cruciate ligament rupture and age-matched control skiers provided a serum sample and self-reported menstrual history data immediately after injury. Both serum concentrations of progesterone and menstrual history were then used to group subjects into either preovulatory or postovulatory phases of the menstrual cycle. RESULTS: Analysis of serum concentrations of progesterone revealed that alpine skiers in the preovulatory phase of the menstrual cycle were significantly more likely to tear their anterior cruciate ligaments than were skiers in the postovulatory phase (odds ratio, 3.22; 95% confidence interval, 1.09-9.52; P = .027). Analysis of menstrual history data found similar results, but the difference was not statistically significant (odds ratio, 2.38; 95% confidence interval, 0.86-6.54; P = .086). CONCLUSION: The likelihood of sustaining an anterior cruciate ligament injury does not remain constant during the menstrual cycle; instead, the risk of suffering an anterior cruciate ligament disruption is significantly greater during the preovulatory phase of the menstrual cycle compared with the postovulatory phase. CLINICAL RELEVANCE: Phase of menstrual cycle may be one of the risk factors that influence knee ligament injury among female alpine skiers. The findings from this study should be considered in subsequent studies designed to identify persons at risk for anterior cruciate ligament injury and to develop intervention strategies.