Prospective radiographic and clinical outcomes and complications of single solid rod instrumented anterior spinal fusion in adolescent idiopathic scoliosis.

STUDY DESIGN: Prospective clinical cases series. OBJECTIVES: To prospectively evaluate outcomes and critically review radiographic results and complications associated with single solid rod anterior spinal fusions in adolescent idiopathic scoliosis with 2-year minimum follow-up (range, 2-6 years). METHODS: Ninety consecutive patients at a single institution with thoracic (n = 43) or thoracolumbar/lumbar (n = 47) adolescent idiopathic scoliosis were treated by one of two surgeons with a similar anterior surgical technique using rib autograft, intradiscal structural (Harms) cages placed below T12, and anterior single solid rod convex compressive instrumentation. The patients were evaluated prospectively with the Scoliosis Research Society outcome instrument and upright radiographs before surgery and minimum 2-year follow-up. RESULTS (RADIOGRAPHIC): The average coronal correction of thoracic curves was from 55 degrees to 29 degrees (47%). The average correction of thoracolumbar/lumbar curves was from 50 degrees to 15 degrees (70%). In the sagittal plane, kyphosis was improved in thoracic fusions from 23 degrees to 30 degrees (T5-T12) and lordosis maintained in thoracolumbar/lumbar fusions at -58 degrees (T12-sacrum). Five patients (5.5%) developed a pseudarthrosis, four with implant failure. Three of five required a posterior fusion for a reoperation rate of 3.3%. The fourth and fifth patients were asymptomatic and appeared fused at the 2-year follow-up, with minimal loss of correction. Common risk factors for pseudarthrosis were smoking (4 of 5), weight >70 kg (4 of 5), and for thoracic pseudarthrosis, hyperkyphosis >40 degrees T5-T12 (2 of 3). RESULTS (CLINICAL OUTCOME): Scoliosis Research Society domain average scores were improved for function, pain, and self-image (P < 0.01). With the Scoliosis Research Society satisfaction domain, 88% responded that they were satisfied with their results and 89% would undergo the same treatment again. Four of five patients with pseudarthrosis did not have statistically significant lower final Scoliosis Research Society scores than those with solid fusions (93 vs. 97, P = 0.18). CONCLUSION: Anterior instrumented fusions for adolescent idiopathic scoliosis using a single solid rod had good radiographic and clinical outcomes. Consideration should be given to alternate techniques in larger adolescents (>70 kg) with thoracic hyperkyphosis (>40 degrees ), and smoking should be avoided. Poor radiographic outcomes did not correlate with final Scoliosis Research Society scores.

Prospective comparison of flexibility radiographs in adolescent idiopathic scoliosis.

STUDY DESIGN: A prospective evaluation of radiographs in patients undergoing anterior spinal fusion or posterior spinal fusion for adolescent idiopathic scoliosis. OBJECTIVE: To determine the most effective preoperative radiographic method for evaluating coronal plane flexibility by comparing preoperative and postoperative correction. SUMMARY OF BACKGROUND DATA: Curve flexibility is traditionally evaluated with side-bending radiographs. Recently, the fulcrum-bending radiograph was shown to provide better correction of thoracic curves undergoing posterior spinal fusion but was not evaluated in thoracolumbar/lumbar curves or in patients undergoing anterior spinal fusion. METHODS: Preoperative coronal radiographs of 46 consecutive patients undergoing spinal fusion for adolescent idiopathic scoliosis obtained while standing, lying supine, side-bending (maximally bending while supine), push-prone (padded bolsters applied to chest wall while prone), and fulcrum-bending (curve apex suspended over a radiolucent fulcrum while lateral) were compared with standing postoperative radiographs. Cobb angles were determined and evaluated for statistical significance. RESULTS: The fulcrum-bending radiograph demonstrated statistically better correction than other preoperative methods for main thoracic curves (P < 0.01) but fell short of demonstrating the correction obtained surgically. There was no statistical difference between side-bending, fulcrum-bending, or postoperative correction for thoracolumbar/lumbar curves (all P values > 0.07). The left side-bending was the most effective method for reducing upper thoracic curves (P < 0.001). There was no difference in the results obtained for curves corrected by anterior spinal fusion or anterior spinal fusion. CONCLUSION: To achieve maximal preoperative correction, thoracic fulcrum-bending radiographs should be obtained for evaluating main thoracic curves, whereas side-bending radiographs should continue to be used for evaluating both upper thoracic and thoracolumbar/lumbar curves.

Historical development of vegetarianism.

Vegetarianism pursued for reasons of physical health is a recent practice historically. Before the 19th century, avoidance of animal food was justified with moral and metaphysical arguments. During the early 1800s, however, an intensified desire for improved health combined with the ascendance of science to a position of cultural authority helped to promote the formulation of physiological arguments for vegetarianism. Theories of the nutritional superiority of a vegetable diet were nevertheless shaped by moral convictions, giving vegetarian spokesmen such as Sylvester Graham and John Harvey Kellogg the appearance of being dietary fanatics. Only as nutritional science expanded from the mid-20th century onward did vegetarianism acquire general recognition as a healthful dietary alternative. But because that alternative is still often selected for moral or other nonscientific reasons, nutritional education of vegetarians remains an essential activity.

Comparison of parents' leadership styles: perceptions of parents and student leaders.

The Parent Leadership Style instrument was completed by 99 students enrolled in a leadership program and also by 129 of their parents. Data were analyzed and reported according to predominant leadership style (Telling, Selling, Participating, and/or Delegating) and effectiveness of leadership. A comparison was made between the parents' self-perceptions and how their children as student leaders perceived their parents. Some suggestions for parents are made relative to the development of leadership skills in students.

Comparison of the Kaufman Assessment Battery for Children (Achievement Scale) and the Basic Achievement Skills Individual Screener for learning disabled students.

The Kaufman Assessment Battery for Children--Achievement Scale and Basic Achievement Skills Individual Screener were administered to 40 students previously identified as learning disabled. Pearson coefficients between the sets of scores on various subtests ranged from .03 to .70.

Comparison of the Test of Nonverbal Intelligence and Wechsler Intelligence Scale for children--revised in rural Native American and white children.

The Test of Nonverbal Intelligence (TONI) and Wechsler Intelligence Scale for Children--Revised (WISC--R) were administered to 46 Native American and white students who were suspected by their classroom teachers of having learning handicaps. Pearson correlations between these sets of IQs ranged from .42 (TONI and WISC--R Performance) to .89 (WISC--R Verbal and Full Scale).

Comparison of the 1979 and the 1986 norms on the Standard Progressive Matrices for economically disadvantaged students: implications for identification of gifted children.

The focus of this article is on a comparison of the 1979 (British) and 1986 (United States) norms for the Standard Progressive Matrices. To screen for potentially gifted children, 307 students in Grades 3 through 8 were tested, and the scores were analyzed using both sets of norms. The 1986 norms may identify more students above criterion. Results are discussed.

Comparison of group measures in identification of rural, culturally diverse gifted students.

The focus of this article is on the identification of rural, culturally diverse gifted children. The Culture-fair Intelligence Test and the Standard Progressive Matrices were administered to 652 students enrolled in Grades 3 to 8 of rural elementary schools. Scores from these two tests and the California Achievement Test are reported. Their usefulness in the identification of gifted children is discussed.

Comparison of four serotests for the detection of Dirofilaria immitis infection in dogs.

Three hundred two dogs were tested with 4 serotests for heartworm antigen (AG) or antibody (AB) and with the Knott test. The 4 serotests evaluated were an enzyme-linked immunosorbent assay (ELISA) for adult heartworm-specific AB (AB-ELISA), a quantitative, indirect immunofluorescent assay (IFA) for adult heartworm-specific AB (AB-IFA), an IFA test for microfilaria (MF)-specific AB (MF-IFA), and an ELISA for adult heartworm AG (AG-ELISA). The presence of heartworms was ascertained in all dogs by necropsy examination. Of 302 dogs, 20 (6.6%) had heartworms in the heart at necropsy. Of infected dogs, 9 (45%) had occult infections. Test sensitivities were 75%, 95%, 70%, and 75% for the AB-ELISA, AB-IFA, MF-IFA, and AG-ELISA, respectively. Test specificities were 85% (AB-ELISA), 77% (AB-IFA), 87% (MF-IFA), and 99% (AG-ELISA). The best agreement between serotest results and necropsy findings was obtained with the AG-ELISA (97%). The 4 serotests detected 86% (AB-ELISA), 100% (AB-IFA), 67% (MF-IFA), and 78% (AG-ELISA) of the dogs with occult heartworm infection. A significant (P less than 0.05) association between intestinal parasitism and positive heartworm test results was found with only AB-IFA. Seemingly, the Knott test, or some other concentration method for detecting circulating MF should be the first heartworm test performed. If the examination for MF is negative, the dog has clinical signs, and radiographic findings are suggestive of occult heartworm infection, then a serotest for adult heartworm AG is recommended.

Five-month oral (diet) toxicity/infectivity study of Bacillus thuringiensis insecticides in sheep.

Bacillus thuringiensis insecticides (Bt) [Dipel (test substance D or Thuricide-HP (test substance T)] were administered in the diet for 5 months to castrated mixed rambouillet/merino sheep (24-34 kg at the beginning of the study) at a dose of 500 mg/kg/day (approximately 10(12) spores per day). No treatment-related effect was seen on weight gain or clinical chemistry parameters nor were significant gross clinical changes observed. Several blood and tissue samples taken just prior to the time the animals were killed or at necropsy were found to be positive for Bt when cultured. Detailed gross and microscopic pathologic examination of the sheep revealed several incidental lesions. However, the only lesion that may have been associated with the treatment was lymphocytic hyperplasia in Peyer's patches seen in the cecum of three sheep and it was not considered to be clinically significant.