Faculty Bibliography

The coronavirus (COVID-19) pandemic triggered wide scale implementation of telemedicine in the United States. The government response, Coronavirus Aid, Relief, and Economic Security (CARES) Act, permitted loosening of existing restrictions on telemedicine enabling its rapid incorporation into the delivery of medical care for children and adults. Prior to COVID-19, few pediatric physiatrists had opportunities to access high fidelity telemedicine platforms to provide health care for patients with special needs, mobility impairments, developmental delays, neuromuscular disorders or other complex medical conditions. This literature review will explore how telemedicine can optimize health care delivery options for pediatric physiatrists in various inpatient and outpatient settings such as consultations, acute inpatient units, outpatient clinics and long-term care facilities. Detailed analysis of the current research in telemedicine applications as well as a critical review of the limitations and barriers for its use offers a plethora of opportunities for enhancement of continuity and coordination of care. Telemedicine may decrease healthcare disparities and increase access of care for children with special needs. Additional research is needed to assess the efficacy of telemedicine when addressing complex medical conditions in children.

INTRODUCTION: Syringomyelia is a disorder in which a cyst, or syrinx, develops within the spinal cord. Historically, syringomyelia in post-traumatic spinal cord injury has been uncommon; however, its diagnosis has been increasing due to the advances in medical technology. Syringomyelia that involves the entire spinal cord, or holocord, is rare after traumatic spinal cord injury, with only a few cases reported in the literature. CASE PRESENTATION: We present a case of a 57-year-old male who had a motorcycle accident 30 years ago resulting in a spinal cord injury, who presented a rapid decline in the function of his left upper extremity. Imaging studies were reviewed to reveal an expansive T2 hyperintense intramedullary spinal cord lesion from C1 inferiorly to the conus medullaris. The patient underwent a T6-T7 laminectomy for the placement of a syringosubarachnoid shunt. The patient was then transferred to acute inpatient rehabilitation where he underwent an intense course of therapy for 3 weeks while being monitored closely by physiatrists. DISCUSSION: The patient was able to make significant recovery and was successfully discharged home. There are a limited number of reports published about post-traumatic holocord syringomyelia. It is important to recognize this diagnosis during follow-up visits with spinal cord injury patients.

BACKGROUND: Optimal leg alignment is the goal of tibial osteotomy. The Taylor Spatial Frame (TSF) and the Ilizarov method enable gradual realignment of angulation and translation in the coronal, sagittal, and axial planes, therefore, the term six-axis correction. QUESTIONS/PURPOSES: We asked whether this approach would allow precise correction of tibial deformities. METHODS: We retrospectively reviewed 102 patients (122 tibiae) with tibial deformities treated with percutaneous osteotomy and gradual correction with the TSF. The proximal osteotomy group was subdivided into two subgroups to distinguish those with an intentional overcorrection of the mechanical axis deviation (MAD). The minimum followup after frame removal was 10 months (average, 48 months; range, 10-98 months). RESULTS: In the proximal osteotomy group, patients with varus and valgus deformities for whom the goal of alignment was neutral or overcorrection experienced accurate correction of MAD. In the proximal tibia, the medial proximal tibial angle improved from 80 degrees to 89 degrees in patients with a varus deformity and from 96 degrees to 85 degrees in patients with a valgus deformity. In the middle osteotomy group, all patients had less than 5 degrees coronal plane deformity and 15 of 17 patients had less that 5 degrees sagittal plane deformity. In the distal osteotomy group, the lateral distal tibial angle improved from 77 degrees to 86 degrees in patients with a valgus deformity and from 101 degrees to 90 degrees for patients with a varus deformity. CONCLUSIONS: Gradual correction of all tibial deformities with the TSF was accurate and with few complications. LEVEL OF EVIDENCE: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.