Faculty Bibliography

Background/UNASSIGNED:A variety of techniques have been utilized to improve the accuracy of pedicle screw instrumentation. Recently, a novel handheld computerized drill system, IntelliSense Drill Technology, has been used in orthopedic trauma to improve drilling accuracy and reduce radiation and iatrogenic injury. The specialized drill technology detects changes in cortical density to prevent inadvertent cortical violation. The aim of this study is to assess the ability of this system to identify pedicle trajectories in the thoracic and lumbar spine compared to a standard freehand technique. Methods/UNASSIGNED:Two spine surgeons, including 1 senior-level and 1 junior-level attending drilled pedicle screw tracts using a freehand technique and computerized drill technology in 4 cadaveric spines from T2 to S1. A total of 134 pedicle screws were placed, including 70 by the senior surgeon and 64 by the junior surgeon. Cortical violations were assessed using computed tomography after instrumenting each pedicle tract, and procedure time for insertion of pedicle screws was recorded. Results/UNASSIGNED: = .063). Conclusions/UNASSIGNED:We demonstrate the use of a novel drill technology for placement of pedicle screws in the thoracic and lumbar spine. After an initial learning curve, this technology is comparable to use of a freehand technique by both a senior-level and a junior-level attending surgeon in a cadaveric model. Further investigation is needed to identify the clinical role of this technology in spine surgery.

BACKGROUND CONTEXT: Adolescent idiopathic scoliosis (AIS) is largely an asymptomatic condition with little impact on function in a young, active population. Little is known about the level of activity of the postoperative AIS patient other than from non-descriptive patient outcome questionnaires. PURPOSE: The purpose of this study was to assess return to sports participation in operatively treated AIS patients. STUDY DESIGN/SETTING: Retrospective questionnaires were administered to consecutively enrolled operative AIS patients. PATIENT SAMPLE: Operative AIS patients. OUTCOME MEASURES: Intensity and time spent in the sport after surgery for AIS. METHODS: A retrospective study of consecutive operative AIS patients presenting for their 1- or 2-year postoperative visits and who were engaged in a sport or dance regularly before surgery were administered the SRS-22, Activity Questionnaire for Adults and Adolescents (AQuAA) and a customized questionnaire on return to sport. The intensity and time spent in the sport were compared pre- and postsurgery using Wilcoxon signed-rank tests. RESULTS: 38 patients were enrolled (age 14.2 yrs; 84.2% female; 36 PSF, 2 combined approaches; levels fused 9.5; mean FU 1.5 yrs). 36/38 (94.7%) returned to their sports after surgery. Median times to begin training after surgery was 3-6 months and to fully return to sport was 6-12 months. Among these 36 patients, 29 (80.6%) were able to return to their previous or a higher level of competition. Nine (25%) patients had reduced intensity of participating sport (p=0.0005). Most frequently played sports after surgery were: in Contact category Football (5.3%), in Light Contact category: Baseball/Softball (23.7%), Soccer (15.8%) and Volleyball (15.8%); in Noncontact category: Swimming/Diving (26.3%), Dance (23.7%) and Track & Field (13.2%); and in Recreational category: Running/Jogging (44.7%), Swimming (noncompetitive, 28.9%) and Strength training (23.7%) (please note that patients may participate in multiple sports within and!

OBJECTIVE: To alert athletic trainers to the signs and symptoms of idiopathic thrombocytopenic purpura and its clinical presentation in order to facilitate immediate intervention. BACKGROUND: Idiopathic thrombocytopenic purpura (ITP), also known as immune thrombocytopenic purpura, is a hemorrhagic disorder that is primarily immunologic in origin but is sometimes triggered by viral infection in children. It has also been associated with heroin and quinine drug use. A reduced platelet count can result in mucosal or deep tissue bleeding, or both, and most importantly, intracranial bleeding. Because football is a collision sport, it is imperative that any player presenting with ITP-type symptoms be removed immediately from all contact and referred to a physician. DIFFERENTIAL DIAGNOSIS: Leukemia, aplastic anemia, drug side effects, vitamin deficiency, kidney failure, infection, multiple contusions. TREATMENT: The traditional first-line treatment consists of corticosteroid medication and time and removal from all physical activities until the blood platelet count is normal and controlled. In quinine-induced ITP, discontinuation of the drug and bedrest are recommended to reduce the risk of major hemorrhage for a 12-to 14-hour period in order to allow the quinine to clear the system and the platelet count to return to normal. UNIQUENESS: ITP's presentation needs to be differentiated from other disorders. Incorrect diagnosis could seriously jeopardize the athlete, who could develop intracranial and internal bleeding. CONCLUSIONS: Recognition of the signs and symptoms associated with ITP is essential to prevent further participation by the athlete. Immediate intervention is needed to determine the severity and to institute appropriate treatment

One hundred and seventy-seven patients who had adolescent idiopathic scoliosis were followed from the time of the initial evaluation to skeletal maturity or arthrodesis. At that time, we analyzed the degree of curvature to determine if it was related to parental age at the time of the patient's birth. Patients who were born to mothers who were twenty-seven years old or more had a mean curve of 35.2 degrees, which was significantly greater (p = 0.02) than that of patients whose mothers were younger than twenty-seven years, who had a mean curve of 30.4 degrees. More patients whose mothers were twenty-seven years old or older ultimately needed arthrodesis than did those whose mothers were younger than twenty-seven years (26 compared with 12 per cent). Therefore, a maternal age of twenty-seven years old or more is a risk factor for greater progression of the curve and indicates a potential need for arthrodesis. No difference in the degree of curvature was seen when the patients were grouped according to paternal age.