Faculty Bibliography

Lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ+) individuals may encounter added challenges in the healthcare setting. Both providers and patients may face discrimination based on their sexual orientation or gender identity, which may lead to avoidance or delay in seeking care. LGBTQ+ physicians often choose not to disclose their sexual orientation because of concerns about harassment, isolation, and depression. Orthopaedic surgery remains the least diverse medical specialty and there is inconsistent training about the needs and cultural issues that affect sexual and gender minority individuals. Furthermore, orthopaedic research specific to LGBTQ+ patients and physicians is exceedingly limited. By encouraging mentorship and improving awareness of the challenges that this community faces, the field of orthopaedic surgery can work to foster an open and inclusive environment that is conducive to the experience of all patients, trainees, and healthcare personnel.

Study Design. Retrospective review of prospectively collected surgical dataObjective. This study sought to determine the effect of fellow education over the course of the academic year (August - July) on surgical outcomes in adolescent idiopathic scoliosis (AIS). One surgeon and one type of surgery were chosen to minimize confounding factors.Summary of Background Data. Educating and training the next generation of physicians and surgeons is necessary for the survival and continuation of medical care. There has been recent momentum to scientifically document that medical education is safe. Spine surgery is complex and demanding, with a steep learning curve making it an ideal model to detect any potential negative impact of medical education.Methods. Subjects: adolescent patients undergoing posterior spinal surgery, between August 2007-July 2010, by a single senior surgeon at one institution with a fellow as the only surgical assistant. Demographic and perioperative data were collected then segmented by surgical date into quarters according to the rotations of the academic year. One fellow was included in each quarter over four years, resulting in 16 fellows across the four quarters. An ANOVA was used to assess differences in operative time, blood loss, length of stay and complications between the quarters of the year.Results. There were no significant differences between the groups regarding age, sex, or Lenke curve type. No statistically significant differences were found between the four quarters of the fellowship year for estimated blood loss, use of cell saver, length of stay, operative time, and complication rate.Conclusions. This study is the first to show that fellow education over the course of the academic year did not impact the patient outcomes studied. It is clear that while there is significant academic benefit for the fellows as they complete their spine fellowship, there is no negative impact for patients.

BACKGROUND: The increased prevalence of spinal fusion surgery has created an industry focus on bone graft alternatives. While autologous bone graft remains the gold standard, the complications and morbidity from harvesting autologous bone drives the search for reliable and safe bone graft substitutes. With the recent information about the adverse events related to bone morhogenetic protein use, it is appropriate to review the literature about the numerous products that are not solely bone morphogenetic protein. PURPOSE: The purpose of this literature review is to determine the recommendations for use of non-bone morphogenetic protein bone graft alternatives in the most common spine procedures based on a quantifiable grading system. STUDY DESIGN: Systematic literature review. METHODS: A literature search of MEDLINE (1946-2012), CINAHL (1937-2012), and the Cochrane Central Register of Controlled Trials (1940-April 2012) was performed, and this was supplemented by a hand search. The studies were then evaluated based on the Guyatt criteria for quality of the research to determine the strength of the recommendation. RESULTS: In this review, more than one hundred various studies on the ability of bone graft substitutes to create solid fusions and good patient outcomes are detailed. CONCLUSION: The recommendations for use of bone graft substitutes and bone graft extenders are based on the strength of the studies and given a grade.

STUDY DESIGN/METHODS:Retrospective radiographic review. OBJECTIVE:To assess the utility of lateral dynamic flexion-extension radiographs in the initial evaluation of the degenerative lumbar spine. SUMMARY OF BACKGROUND DATA/BACKGROUND:Most surgeons obtain standing anteroposterior (AP) and lateral radiographs in the initial evaluation of patients presenting with lumbar complaints. The potential role of dynamic films in this population has not been established. METHODS:Of a 390 radiograph series, 342 met inclusion criteria and were reviewed. After assessment of the AP and lateral radiographs, dynamic films were evaluated to determine if additional information was obtained. RESULTS:Only 2 of the 342 radiographic series had new findings seen on dynamic films not appreciated on the AP and lateral films (a L3-L4 anterolisthesis of 3 mm with flexion and a L5-S1 retrolisthesis of 4 mm with extension). Fifteen additional radiographic series were noted to have a change in the amount of anterolisthesis or retrolisthesis on the dynamic films (changes ranged from 2 to 5 mm). CONCLUSION/CONCLUSIONS:In the population studied, dynamic radiographs did not significantly alter the initial course of clinical management beyond standing AP and lateral lumbar images.