Clinical evaluation of pediatric patient with spondylolisthesis

© Springer Science+Business Media New York 2015. Pediatric patients presenting with spondylolisthesis require a thorough physical examination. While the majority of these patients will present with back pain, occasionally the initial finding is simply spinal deformity or abnormal gait. Reported symptoms may be minimal in the pediatric population with spondylolisthesis, regardless of the degree of deformity, so a careful and complete physical exam is necessary to document all associated deficits. The exam begins by documenting a thorough history including presenting symptoms, duration, and aggravating or relieving factors. A general inspection of the spinal posture, palpation, spinal range of motion assessment, gait abnormalities, a complete neurologic exam, and special physical exam tests are needed as well. Complaints or findings of motor weakness, sensory changes, or urologic abnormalities which are identified require further evaluation or imaging. In general, despite the range of severity of presenting symptoms found in pediatric patients with spondylolisthesis, evaluating all patients with this thorough physical exam will allow the treating physician to fully assess the impact of the spinal pathology and select appropriate treatment

Radiographic Resource Utilization in the Initial Referral and Evaluation of Patients with Adolescent Idiopathic Scoliosis

© Copyright 2018 by the American Academy of Orthopaedic Surgeons. Introduction: The dangers of radiation exposure in children have been well studied, with assessment of adolescent idiopathic scoliosis (AIS) documented as having the potential for notable patient exposure. The purposes of this study were to evaluate a consecutive series of patients referred to a tertiary care pediatric hospital for AIS and to assess the type and quality of imaging obtained before referral for specialist evaluation. Methods: We performed a prospective study of consecutive patients referred over a 6-month period to a pediatric orthopaedic practice at a large, free-standing, urban children\u27s hospital for evaluation of AIS. We assessed prereferral radiographic exposure, evaluating the utilization and adequacy of these radiographs. Results: Of a total of 131 patients enrolled in the study, 79 had received radiographs before the visit; of these, only 59 patients (75%) brought the previously obtained radiographs to the specialist consultation, and 45 patients (76%) of this subset were found to be adequate for evaluation of AIS. Of the total cohort, 56 patients (43%) required repeat radiographs because of missing or inadequate radiographs. Discussion: We found a large number of missing or inadequate radiographs, leading to repeat radiation exposure in this cohort. Improvements in the utilization of radiographs before orthopaedic referral could decrease unnecessary patient radiation exposure

Radiographic Outcome Differences in Distraction-Based Growing Rod Constructs Using Tandem Versus Wedding Band Connectors

© 2017 Scoliosis Research Society Study Design: Comparative cohort study. Objective: To compare coronal deformity control, lengthening efficacy, and sagittal alignment between distraction-based growing rod constructs utilizing tandem versus wedding band connectors. Summary of Background Data: Different construct designs exist for growing rod treatment of early-onset scoliosis. All use a version of a rod connector, with the two main types being tandem and wedding band. Little data exist to quantify the impact of connector choice on radiographic outcomes of treatment. Methods: A multicenter database of prospectively and retrospectively collected data on early-onset scoliosis patients was reviewed. Patients of any thoracic or thoracolumbar coronal plane deformity whose initial growing rod treatment was initiated before age 10 years and underwent at least 3 years of dual growing rod treatment with either tandem or wedding band connectors were included. Preoperative, immediate postoperative, and prefinal radiographs were reviewed and compared in regard to major curve magnitude, T1–T12 and T1–S1 spinal length, length of instrumentation, and sagittal plane measures. Results: A total of 209 patients were included. The overall percent change from preoperative to prefinal in all radiographic parameters was not different between the two groups indicating similar efficacy in treatment. After controlling for institutional variation, the improvement of the major coronal Cobb angle from preoperative to prefinal was statistically improved for the tandem group (34° vs. 29° p =.002) and the difference in T5–T12 kyphosis from preoperative to prefinal was significantly different between the groups (−6° vs. +1.3° p =.008). Conclusion: We identified little difference in the effects of connector type on radiographic outcomes of patients treated with traditional growing rod, which indicates that both wedding band and tandem connectors function similarly. The small differences detected suggest that tandem connectors may improve major Cobb correction, and wedding band connectors may maintain thoracic kyphosis over time. Level of Evidence: Level II