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Increased Risk of Infection in Obese Adolescents After Pedicle Screw Instrumentation for Idiopathic Scoliosis

Katyal, Chhavi; Grossman, Seth; Dworkin, Aviva; Singer, Lewis; Amaral, Terry; Sugarman, Etan; Wollowick, Adam; Sarwahi, Vishal
STUDY DESIGN/METHODS:Original research. OBJECTIVE:To evaluate perioperative risk factors associated with obesity in children undergoing posterior spinal fusion for adolescent idiopathic scoliosis. The authors hypothesized that patients with a high body mass index (BMI) percentile would be associated with increased morbidity as measured by various intraoperative parameters. SUMMARY OF BACKGROUND DATA/BACKGROUND:Few studies have evaluated the effects of increased BMI in children undergoing surgery. Adolescent idiopathic scoliosis represents 80% of idiopathic scoliosis cases and is the most common indication for surgery. METHODS:Patients were divided into 3 groups: normal weight (n = 144) (5% < BMI < 85%), overweight (n = 25) (BMI > 85% to 95%), and obese (n = 38) (BMI > 95%). Patients with BMI less than 5% were excluded from this study because they were underweight. Perioperative data were collected and analyzed based on differences between groups. RESULTS:A total of 207 patients were included in this study. There was a significant difference in the length of anesthesia (p = .032). The rate of infection was 11% in the obese group, 12% in the overweight group, and 3% in the normal weight group (p = .03). CONCLUSIONS:Even with pedicle screw instrumentation, the researchers saw an increase in infection in overweight and obese patients. Patients should be counseled before surgery for weight loss to limit surgical complications such as possible risk of postoperative wound infection.
PMID: 27927308
ISSN: 2212-1358
CID: 4507922

Anterior release generates more thoracic rotation than posterior osteotomy: a biomechanical study of human cadaver spines

Wollowick, Adam L; Farrelly, Erin E; Meyers, Kathleen; Grossman, Seth; Amaral, Terry D; Wright, Timothy; Sarwahi, Vishal
STUDY DESIGN/METHODS:Biomechanical testing of human cadaveric spines. OBJECTIVE:To determine the effect of anterior and posterior anatomic structures on the rotational stability of the thoracic spine. SUMMARY OF BACKGROUND DATA/BACKGROUND:Historically, large and/or stiff spinal deformities were treated with anterior release to facilitate correction. However, anterior release increases risks and requires a 2-part procedure. Recently, large or rigid deformities have been treated with a single posterior procedure using pedicle screws and spinal osteotomies. No study has yet evaluated the effect of anterior release or posterior osteotomy on thoracic spinal column rotation. METHODS:Thoracolumbar spines were obtained from cadavers and segmented into upper, middle, and lower specimens. Specimens were cyclically loaded with a ±5 N·m moment in axial rotation for 10 cycles. Specimens were tested intact and then retested after sectioning or removal of each structure to simulate those removed during anterior release and posterior osteotomy. The total increases in axial rotation after posterior and anterior resections were calculated using a 3-dimensional motion capture camera system. For each ligament resection, the absolute and percent change in degrees of rotation was calculated from comparison with the intact specimen. The median data points were compared to account for outliers. RESULTS:Resection of anterior structures was more efficacious than resection of posterior structures. An 8.8% to 71.9% increase in the amount of axial rotation was achieved by a posterior release, whereas resection of anterior structures led to a 141% to 288% increase in rotation. The differences between the anterior and posterior resections at all levels tested (T2-T3, T6-T7, and T10-T11) were significant (P < 0.05). CONCLUSION/CONCLUSIONS:Anterior release generated significantly more thoracic rotation than posterior osteotomy in biomechanical testing of human cadaver spines. LEVEL OF EVIDENCE/METHODS:N/A.
PMID: 23680828
ISSN: 1528-1159
CID: 4507912

Clinical presentation of pulmonary embolus after total joint arthroplasty: do size and location of embolus matter?

Pulido, Luis; Grossman, Seth; Smith, Eric B; Joshi, Ashish; Purtill, James J; Parvizi, Javad; Rothman, Richard H
Pulmonary embolism (PE) is a potentially fatal complication of total joint arthroplasty. Therefore, it is essential to have reliable means for diagnosis and evaluation of severity. In the study reported here, we evaluated the reliability of common clinical signs and symptoms in the diagnosis of PE. In addition, we used correlation analysis to assess for a correlation between clinical presentation and size and location of the embolus within the pulmonary vasculature. Included in this study were 13,133 patients who underwent total joint arthroplasty between 2000 and 2005. PE was diagnosed in 144 patients (1.1%). Shortness of breath (31.9%) and hypotension (30.6%) were the most frequent symptom and sign. Oxygen desaturation was the only indication for investigation of PE in 10% of patients. A pulse-oximetry reading of less than 90% was present in 63% of patients, and 92% of patients presented with an increased alveolar-arterial gradient. Overall, clinical signs and symptoms as well as severity of hypoxia did not correlate with size and location of PE. Patients with PE demonstrated a significant decrease in arterial oxygen content; an abnormal alveolar-arterial gradient was the most consistent finding in these patients. Common clinical signs and symptoms, as well as changes in vital signs, have a low sensitivity for diagnosis.
PMID: 20512171
ISSN: 1934-3418
CID: 4507902

The inferior vena cava filter is effective in preventing fatal pulmonary embolus after hip and knee arthroplasties

Austin, Matthew S; Parvizi, Javad; Grossman, Seth; Restrepo, Camilo; Klein, Gregg R; Rothman, Richard H
Thromboembolic disease is a relatively common and potentially devastating complication of joint arthroplasty. Mechanical and chemical prophylaxes are effective in reducing the incidence of this complication. Inferior vena cava (IVC) filters have been used to prevent the propagation and/or migration of venous emboli into the pulmonary circulation. This article reports on a cohort of joint arthroplasty patients either with confirmed pulmonary embolism or at high risk of developing pulmonary emboli in whom an IVC filter was implanted. Using the institutional database, 95 joint arthroplasty patients who received an IVC filter were identified. The IVC filter was effective in preventing fatal pulmonary emboli in all patients. The IVC filter is a valuable and effective modality in preventing a fatal outcome of thromboembolism in patients with established thromboembolism
PMID: 17400088
ISSN: 0883-5403
CID: 141306

Management of lower-extremity bone metastasis

Weber, Kristy L; Randall, R Lor; Grossman, Seth; Parvizi, Javad
PMID: 17142431
ISSN: 0021-9355
CID: 4507892