Dennis Devito - Academia.edu (original) (raw)
Papers by Dennis Devito
Journal of Spinal Disorders, Sep 1, 1991
Foot & ankle, Oct 1, 1985
Equivalent biomechanical characteristics of human ankle-joint muscles have been determined by imp... more Equivalent biomechanical characteristics of human ankle-joint muscles have been determined by impact and vibration tests. The estimate of the stiffness and damping coefficients has yielded, respectively, (2.67 + 0.48) x 104 N 9 m-1 and (811.58 + 201.3) N 9 s 9 m-1 by impact actions, n = 126; (1.49-4-0.35) • 104 N 9 m-1 and (430.1 + 36.1) N 9 s 9 m-1-by vibration actions, n = 7. The characteristics of the ankle-joint muscles of subjects representing different kinds of sports have proved to be different.
Instructional course lectures, 2020
Back pain and spinal deformity in the pediatric and adolescent patient population are common reas... more Back pain and spinal deformity in the pediatric and adolescent patient population are common reasons for presentation to the orthopaedic surgeon, and although most conditions are benign and self-limiting, a standardized approach to the history and physical examination can identify concerning signs and symptoms as well as aid in determining the final diagnosis and a recommended treatment plan. The most common and concerning etiologies of back pain and spinal deformity will be reviewed, along with nonsurgical and surgical management of these conditions.
World Journal of Orthopedics, 2019
Conflict-of-interest statement: Each author certifies that he or she has no commercial associatio... more Conflict-of-interest statement: Each author certifies that he or she has no commercial associations that might pose a conflict of interest in connection with the submitted article. The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or reflecting the views of the Department of Defense or US Government.
Journal of Spinal Disorders, 1993
Journal of Biomedical Materials Research, 1978
The rates of adhesion of melanoma cells (carcinogenic) onto nonionic polymer surfaces were studie... more The rates of adhesion of melanoma cells (carcinogenic) onto nonionic polymer surfaces were studied by using radioactively labeled cells and measuring the fraction of cells which adhered to the surface in a given time. Glow discharge (plasma) polymerization of 1,1,3,3‐tetramethyldisiloxane and of nitrogen‐acetylene‐water (mole ratio 0.4:1.0:0.2) was used to modify the surface energy of the substrate. The cell adhesion rate was found to be given by Y = 1 − exp [−k0(γs − γ0)t], where Y is the fraction of cells adhered, − k0 is a characteristic rate constant, γs is the total surface energy of the substrate, γ0 is the threshold surface energy of cell adhesion, and t is time.
Journal of Biomedical Materials Research, 1975
Plasma coating (deposition of polymer under the influence of plasma) is utilized to modify the su... more Plasma coating (deposition of polymer under the influence of plasma) is utilized to modify the surface properties of corneal contact lens. An ultrathin layer (thickness of roughly 200 Å) of plasma polymer of acetylene/H2O/N2 is applied to poly(methyl methacrylate) (PMMA) corneal contact lenses. The surface becomes highly wettable with water compared to uncoated lens. When coated and uncoated contact lenses are placed on rabbit eyes, a remarkable difference in accumulation of mucous matter is observed. With the control lenses, the accumulation of mucous matter in a week is sufficient to affect the optical clarity of the lenses, whereas the coated lenses show no change after three months continuous wearing. The comparative degree of adhesion of the corneal epithelium cells onto glass, modified glass, PMMA, and coated PMMA surfaces is studied using tissue cultures and phase contrast microscopy. The coated PMMA surface exhibits a degree of tissue adhesion lower than that of control PMMA...
Spine Deformity, 2020
STUDY DESIGN Laboratory based study. OBJECTIVE To compare reduction force and plastic deformation... more STUDY DESIGN Laboratory based study. OBJECTIVE To compare reduction force and plastic deformation of cobalt-chromium (Co-Cr) spinal rods using a rigid, thoracolumbar spinal deformity model. Pre-contoured spinal rods are growing in their utilization for spinal deformity. Although there are theoretical advantages to pre-contouring rods, no previous studies have compared pre-contoured and manually contoured rods for their ability to maintain sagittal contour and resist mechanical load. METHODS A spinal deformity model was utilized, simulating a rigid, thoracolumbar spinal deformity fixated with pedicle screws. Roll-formed pre-contoured and manually contoured 5.5 mm and 6.0 mm Co-Cr rods were reduced to the model with a load cell attached to the apical screw to measure corrective force. Rods remained reduced in the model for 20 min and change in contour was assessed to characterize plastic deformation. RESULTS Twenty-four rods were tested with six rods per group (Table 1). The load to reduction was significantly lower in the 5.5 mm rods compared to the 6.0 mm rods (95% CI -254.0 to -61.42; p = 0.008). Although there was no difference in the corrective forces for manual and pre-contoured 5.5 mm rods (p = 0.722), the 6.0 mm rod produced significantly less corrective force compared to the manually contoured 6.0 mm rods (95% CI -134.42 to -5.317; p = 0.039). Additionally, rod contour for the manual group showed significantly less plastic deformation than the pre-contoured group in both 5.5 mm and 6.0 mm rods (5.5 mm: 57.1% vs. 61.6%, p = 0.006; 6.0 mm: 54.3% vs. 62.28%, p = 0.003). CONCLUSIONS Roll formed, pre-contoured Co-Cr rods demonstrated significantly greater plastic deformation when compared with manually contoured rods of the same diameter. Furthermore, 6.0 mm pre-contoured rods required significantly lower load for rod reduction, the equivalent of 15 lb-force. Post-manufacturing, roll-formed pre-contouring of larger diameter Co-Cr may impair the rods mechanical properties.
Journal of spinal disorders, 1991
Aneurysmal bone cysts (ABCs) have been reported in essentially every bone of the human skeleton. ... more Aneurysmal bone cysts (ABCs) have been reported in essentially every bone of the human skeleton. This case report documents a very unusual clinical appearance for this entity: a superior mediastinal mass. Also, the patient underwent multiple imaging studies that demonstrated both common (absence of septations) and unusual (extensive involvement of vertebral body with little involvement of posterior elements) characteristics of ABCs.
Spine Deformity, 2021
PURPOSE Intraoperative methadone has been shown to decrease opioid medication requirement followi... more PURPOSE Intraoperative methadone has been shown to decrease opioid medication requirement following posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). No study to date has investigated the effect of methadone on opioid medication requirement when used in conjunction with an enhanced recovery after surgery (ERAS) protocol following PSF. METHODS A retrospective cohort study was performed at a single, tertiary care pediatric hospital. Patients with AIS undergoing PSF were consecutively given a single intra-operative methadone dose and matched 1:2 to a AIS control group without methadone. Patients were matched for age, curve magnitude, levels fused, blood loss, and operating time. All children followed a standard ERAS protocol with methadone being the only change in the post-operative regimen. In-hospital data for opioid and non-opioid medication use, surgical, and patient variables were recorded and compared between cohorts. RESULTS Twenty-six patients received methadone (average 15.1 ± 1.9 years) and were matched with 52 control patients without methadone (average 14.7 ± 2.2 years). There were no significant differences in total opioid usage at any time-interval prior to hospital discharge or in cumulative opioid usage. Additionally, patients had a similar VAS pain level at discharge (methadone: 4.0 ± 2.3 vs control: 3.8 ± 1.9; P = 0.572). Total opioid usage was correlated with LOS. There were no opioid-related medication complications in either cohort. CONCLUSION There was no decrease of in-hospital opioid usage when methadone was used with an ERAS protocol. Total opioid usage is correlated with hospital LOS following PSF.
International Journal of Spine Surgery, 2021
Robotic assistance in surgical procedures is a valuable tool that enhances the safety and efficac... more Robotic assistance in surgical procedures is a valuable tool that enhances the safety and efficacy of invasive surgeries. These devices are divided functionally into surgeon surrogates where the device operates under the direct control of an offsite surgeon, and surgeon adjuncts where the device is an intraoperative guidance tool used in a portion of the procedure. The current state of robotic spine surgery focuses on the latter, addressing the primary task of pedicle screw placement. We would like to share our experience with the Mazor Robotics devices to discuss the underlying concepts, strengths, weaknesses, and results as they pertain to pediatric spine deformity.
Journal of Neurosurgery: Pediatrics, 2021
OBJECTIVEPosterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) can be associate... more OBJECTIVEPosterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) can be associated with significant blood loss. It has been suggested that blood loss is greater in different racial groups. The purpose of this study was to evaluate differences in blood loss between African American and Caucasian patients undergoing PSF for AIS.METHODSA retrospective review was performed of patients aged 10–18 years with AIS who were treated with PSF from 2014 to 2017 at a single children’s healthcare system. Patient demographic, radiographic, and operative data were obtained from medical records. Intraoperative blood loss was calculated using the formula described by Waters et al. Patients who declined reporting their race or had prior spinal surgery, neuromuscular or syndromic diagnoses, a history of cardiac or thoracic surgery, or a bleeding disorder were excluded. Blood loss variables were log-transformed for normality and modeled using multivariable linear regression.RESULTSA tota...
Spine Deformity, 2021
PURPOSE Enhanced Recovery after Surgery (ERAS) pathways have been shown to decrease length of sta... more PURPOSE Enhanced Recovery after Surgery (ERAS) pathways have been shown to decrease length of stay (LOS) after posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). The aim of this study was to compare immediate post-operative outcomes following an ERAS pathway with a traditional pathway for AIS. METHODS A prospective dual-center study of patients treated using an ERAS pathway (203 patients) or a traditional discharge (TD) pathway (73 patients) was performed with focus on pain at discharge, quality of life at one month, and return to school/work. RESULTS LOS was 55% less in the ERAS group (4.8 days TD vs. 2.2 days ERAS, p < 0.001). Length of surgery (4.8 h TD vs. 2.8 h, p < 0.001) and EBL (500 cc vs. 240 cc, p < 0.001) were greater in the TD group, likely related to larger curve magnitudes ((62.0° TD vs. 54.0° ERAS, p < 0.001), a higher percentage of patients undergoing osteotomies (94% vs. 46%, p < 0.001) and more levels fused (11.4 ± 1.6 vs. 10.1 ± 2.6, p < 0.001) in the TD group. Regression analysis showed no difference in Visual Analog Score (VAS) score at discharge or quality of recovery using the QOR9 instrument between groups at follow up. There was no difference in return to school (p = 0.43) and parents' return to work (p = 0.61) between the groups. CONCLUSION Patients managed with an ERAS pathway had similar pain scores at discharge than those managed with a TD pathway. Both groups showed evidence of rapid return to normalcy by the first follow up visit.
Global Spine Journal, 2021
Study Design: Biomechanical Study. Objective: The search for optimal spinal alignment has led to ... more Study Design: Biomechanical Study. Objective: The search for optimal spinal alignment has led to the development of sophisticated formulas and software for preoperative planning. However, preoperative plans are not always appropriately executed since rod contouring during surgery is often subjective and estimated by the surgeon. We aimed to assess whether rods contoured to specific angles with a French rod bender using a template guide will be more accurate than rods contoured without a template. Methods: Ten experienced spine surgeons were requested to contour two 125 × 5.5 mm Ti64 rods to 40°, 60° and 80° without templates and then 2 more rods using 2D metallic templates with the same angles. Rod angles were then measured for accuracy and compared. Results: Average angles for rods bent without a template to 40°, 60° and 80° were 60.2°, 78.9° and 97.5°, respectively. Without a template, rods were overbent by a mean of 18.9°. When using templates of 40°, 60° and 80°, mean bend angle...
Journal of Bone and Joint Surgery, 2020
Background: Closed reduction and percutaneous pinning (CRPP) of supracondylar humeral fractures i... more Background: Closed reduction and percutaneous pinning (CRPP) of supracondylar humeral fractures is one of the most common procedures performed in pediatric orthopaedics. The use of full, standard preparation and draping with standard personal protective equipment (PPE) may not be necessary during this procedure. This is of particular interest in the current climate as we face unprecedented PPE shortages due to the current COVID-19 pandemic. Methods: This is a retrospective chart review of 1,270 patients treated with CRPP of a supracondylar humeral fracture at 2 metropolitan pediatric centers by 10 fellowship-trained pediatric orthopaedic surgeons. One surgeon in the group did not wear a mask when performing CRPP of supracondylar humeral fractures, and multiple surgeons in the group utilized a semisterile preparation technique (no sterile gown or drapes). Infectious outcomes were compared between 2 groups: full sterile preparation and semisterile preparation. We additionally analyzed a subgroup of patients who had semisterile preparation without surgeon mask use. Hospital cost data were used to estimate annual cost savings with the adoption of the semisterile technique. Results: In this study, 1,270 patients who underwent CRPP of a supracondylar humeral fracture and met inclusion criteria were identified. There were 3 deep infections (0.24%). These infections all occurred in the group using full sterile preparation and surgical masks. No clinically relevant pin-track infections were noted. There were no known surgeon occupational exposures to bodily fluid. It is estimated that national adoption of this technique in the United States could save between 18,612 and 22,162 gowns and masks with costs savings of 3.7millionto3.7 million to 3.7millionto4.4 million annually. Conclusions: We currently face critical shortages of PPE due to the COVID-19 pandemic. Data from this large series suggest that a semisterile technique during CRPP of supracondylar humeral fractures is a safe practice. We anticipate that this could preserve approximately 20,000 gowns and masks in the United States over the next year. Physicians are encouraged to reevaluate their daily practice to identify safe opportunities for resource preservation.
Prosthetics and Orthotics International, 2019
Journal of Spine Surgery, 2018
Background: Screw malpositioning is an identifiable cause of intraoperative neurophysiologic chan... more Background: Screw malpositioning is an identifiable cause of intraoperative neurophysiologic changes. Although triggered screw electromyography (t-EMG) has been found to exhibit high sensitivity for identifying malpositioned screws, no previous study has assessed the utility of combining t-EMG with robotic-assisted pedicle screw placement for identifying malpositioned screws. We sought to evaluate the utility of t-EMG used in combination with robotic-assisted pedicle screw placement for identifying malpositioned screws in patients with adolescent idiopathic scoliosis (AIS). Methods: Patients undergoing robotic-assisted posterior spinal fusion with pedicle screw fixation for AIS underwent retrospective review from a single surgeons prospectively collected database. Preoperative demographic data and curve characteristics were recorded. Computed tomography (CT) scans were reviewed, measuring pedicle width and classifying pedicle morphology using the channel classification system. Pedicle data was compared against intra-operative t-EMG data, with a minimal threshold of 8 mA used for screw removal and screw path examination and the rate of screw redirection recorded. All pedicle screws were verified using image intensification. Results: Forty-nine patients (11 males, 38 females, average age 14.49 years) with an average curve magnitude of 51 degrees and placement of 844 pedicle screws to attain an average curve correction of 67.7%. The incidence of an absent pedicle (type C or D morphology) was 2%. Overall, 24 screws (2.8%) were identified with an abnormal t-EMG threshold. All screws were found to have an intact medial wall upon probing and were reinserted without redirection. No patient or curve characteristic was predictive of abnormal t-EMG amplitude but smaller pedicles correlated with smaller amplitudes. Conclusions: With precise pre-operative planning, robotic-assisted pedicle screw placement has shown to be a safe and effective method in treating AIS patients as shown by the lack of medial pedicle breach and malpositioned screws. We found no evidence to support combined use of t-EMG for identifying medially malpositioned screws.
Spine Deformity, 2019
Background: Children with congenital heart disease (CHD) have been reported to be at increased ri... more Background: Children with congenital heart disease (CHD) have been reported to be at increased risk of developing scoliosis following cardiac surgery. Previous sample studies have reported that these patients may safely undergo posterior spinal fusion (PSF) with low complication rates. The goal of this study is to provide an updated analysis of the perioperative complication profile for posterior spinal fusion in a large cohort of pediatric patients with CHD, using a nationwide database. Methods: A retrospective cohort study was conducted using 30-day perioperative outcomes data from the NSQIP-P database. Our inclusion criteria were all pediatric patients who underwent posterior spinal fusion by CPT code. Patients were subdivided into two groups: those with a history of cardiac surgery for CHD and those without. Postoperative complications were classified according to the Clavien-Dindo system. Risk factors were assessed in univariate and multivariate logistic regression analyses, with significance set at p ! .05. Results: Our results included 3,426 pediatric patients (68.2% female, 31.8% male) with a median age at spinal fusion of 13.7 AE 2.87 years. A CHD diagnosis was present in 312 patients, with 128 having had prior cardiac surgery. The overall complication rate was 6.68%, with a 10.9% rate in the prior cardiac surgery cohort (p 5 .068). The most common overall perioperative complications were unplanned readmission (3.5%), reoperation (2.6%), and superficial wound dehiscence (2.5%). Patients with a history of cardiac surgery were not at increased risk for postoperative complications; however, blood transfusion (p ! .001), bronchopulmonary dysplasia (p ! .001), combined bronchopulmonary dysplasia and previous cardiac surgery (p 5 .004), and a neuromuscular diagnosis (p ! .001) were all risk factors for major postoperative complications in this cohort. Conclusions: Children with scoliosis who have undergone cardiac surgery to address CHD are not at an increased risk of perioperative complications within 30 days of undergoing a posterior spinal fusion. However, patients who underwent cardiac surgery for CHD who also had bronchopulmonary dysplasia or an associated neuromuscular diagnosis are at increased risk for perioperative complications. It is important for pediatric orthopedic spine surgeons to be familiar with an updated profile of potential perioperative obstacles they may face when treating these patients, as seen in a large and representative cohort.
Journal of Spinal Disorders, Sep 1, 1991
Foot & ankle, Oct 1, 1985
Equivalent biomechanical characteristics of human ankle-joint muscles have been determined by imp... more Equivalent biomechanical characteristics of human ankle-joint muscles have been determined by impact and vibration tests. The estimate of the stiffness and damping coefficients has yielded, respectively, (2.67 + 0.48) x 104 N 9 m-1 and (811.58 + 201.3) N 9 s 9 m-1 by impact actions, n = 126; (1.49-4-0.35) • 104 N 9 m-1 and (430.1 + 36.1) N 9 s 9 m-1-by vibration actions, n = 7. The characteristics of the ankle-joint muscles of subjects representing different kinds of sports have proved to be different.
Instructional course lectures, 2020
Back pain and spinal deformity in the pediatric and adolescent patient population are common reas... more Back pain and spinal deformity in the pediatric and adolescent patient population are common reasons for presentation to the orthopaedic surgeon, and although most conditions are benign and self-limiting, a standardized approach to the history and physical examination can identify concerning signs and symptoms as well as aid in determining the final diagnosis and a recommended treatment plan. The most common and concerning etiologies of back pain and spinal deformity will be reviewed, along with nonsurgical and surgical management of these conditions.
World Journal of Orthopedics, 2019
Conflict-of-interest statement: Each author certifies that he or she has no commercial associatio... more Conflict-of-interest statement: Each author certifies that he or she has no commercial associations that might pose a conflict of interest in connection with the submitted article. The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or reflecting the views of the Department of Defense or US Government.
Journal of Spinal Disorders, 1993
Journal of Biomedical Materials Research, 1978
The rates of adhesion of melanoma cells (carcinogenic) onto nonionic polymer surfaces were studie... more The rates of adhesion of melanoma cells (carcinogenic) onto nonionic polymer surfaces were studied by using radioactively labeled cells and measuring the fraction of cells which adhered to the surface in a given time. Glow discharge (plasma) polymerization of 1,1,3,3‐tetramethyldisiloxane and of nitrogen‐acetylene‐water (mole ratio 0.4:1.0:0.2) was used to modify the surface energy of the substrate. The cell adhesion rate was found to be given by Y = 1 − exp [−k0(γs − γ0)t], where Y is the fraction of cells adhered, − k0 is a characteristic rate constant, γs is the total surface energy of the substrate, γ0 is the threshold surface energy of cell adhesion, and t is time.
Journal of Biomedical Materials Research, 1975
Plasma coating (deposition of polymer under the influence of plasma) is utilized to modify the su... more Plasma coating (deposition of polymer under the influence of plasma) is utilized to modify the surface properties of corneal contact lens. An ultrathin layer (thickness of roughly 200 Å) of plasma polymer of acetylene/H2O/N2 is applied to poly(methyl methacrylate) (PMMA) corneal contact lenses. The surface becomes highly wettable with water compared to uncoated lens. When coated and uncoated contact lenses are placed on rabbit eyes, a remarkable difference in accumulation of mucous matter is observed. With the control lenses, the accumulation of mucous matter in a week is sufficient to affect the optical clarity of the lenses, whereas the coated lenses show no change after three months continuous wearing. The comparative degree of adhesion of the corneal epithelium cells onto glass, modified glass, PMMA, and coated PMMA surfaces is studied using tissue cultures and phase contrast microscopy. The coated PMMA surface exhibits a degree of tissue adhesion lower than that of control PMMA...
Spine Deformity, 2020
STUDY DESIGN Laboratory based study. OBJECTIVE To compare reduction force and plastic deformation... more STUDY DESIGN Laboratory based study. OBJECTIVE To compare reduction force and plastic deformation of cobalt-chromium (Co-Cr) spinal rods using a rigid, thoracolumbar spinal deformity model. Pre-contoured spinal rods are growing in their utilization for spinal deformity. Although there are theoretical advantages to pre-contouring rods, no previous studies have compared pre-contoured and manually contoured rods for their ability to maintain sagittal contour and resist mechanical load. METHODS A spinal deformity model was utilized, simulating a rigid, thoracolumbar spinal deformity fixated with pedicle screws. Roll-formed pre-contoured and manually contoured 5.5 mm and 6.0 mm Co-Cr rods were reduced to the model with a load cell attached to the apical screw to measure corrective force. Rods remained reduced in the model for 20 min and change in contour was assessed to characterize plastic deformation. RESULTS Twenty-four rods were tested with six rods per group (Table 1). The load to reduction was significantly lower in the 5.5 mm rods compared to the 6.0 mm rods (95% CI -254.0 to -61.42; p = 0.008). Although there was no difference in the corrective forces for manual and pre-contoured 5.5 mm rods (p = 0.722), the 6.0 mm rod produced significantly less corrective force compared to the manually contoured 6.0 mm rods (95% CI -134.42 to -5.317; p = 0.039). Additionally, rod contour for the manual group showed significantly less plastic deformation than the pre-contoured group in both 5.5 mm and 6.0 mm rods (5.5 mm: 57.1% vs. 61.6%, p = 0.006; 6.0 mm: 54.3% vs. 62.28%, p = 0.003). CONCLUSIONS Roll formed, pre-contoured Co-Cr rods demonstrated significantly greater plastic deformation when compared with manually contoured rods of the same diameter. Furthermore, 6.0 mm pre-contoured rods required significantly lower load for rod reduction, the equivalent of 15 lb-force. Post-manufacturing, roll-formed pre-contouring of larger diameter Co-Cr may impair the rods mechanical properties.
Journal of spinal disorders, 1991
Aneurysmal bone cysts (ABCs) have been reported in essentially every bone of the human skeleton. ... more Aneurysmal bone cysts (ABCs) have been reported in essentially every bone of the human skeleton. This case report documents a very unusual clinical appearance for this entity: a superior mediastinal mass. Also, the patient underwent multiple imaging studies that demonstrated both common (absence of septations) and unusual (extensive involvement of vertebral body with little involvement of posterior elements) characteristics of ABCs.
Spine Deformity, 2021
PURPOSE Intraoperative methadone has been shown to decrease opioid medication requirement followi... more PURPOSE Intraoperative methadone has been shown to decrease opioid medication requirement following posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). No study to date has investigated the effect of methadone on opioid medication requirement when used in conjunction with an enhanced recovery after surgery (ERAS) protocol following PSF. METHODS A retrospective cohort study was performed at a single, tertiary care pediatric hospital. Patients with AIS undergoing PSF were consecutively given a single intra-operative methadone dose and matched 1:2 to a AIS control group without methadone. Patients were matched for age, curve magnitude, levels fused, blood loss, and operating time. All children followed a standard ERAS protocol with methadone being the only change in the post-operative regimen. In-hospital data for opioid and non-opioid medication use, surgical, and patient variables were recorded and compared between cohorts. RESULTS Twenty-six patients received methadone (average 15.1 ± 1.9 years) and were matched with 52 control patients without methadone (average 14.7 ± 2.2 years). There were no significant differences in total opioid usage at any time-interval prior to hospital discharge or in cumulative opioid usage. Additionally, patients had a similar VAS pain level at discharge (methadone: 4.0 ± 2.3 vs control: 3.8 ± 1.9; P = 0.572). Total opioid usage was correlated with LOS. There were no opioid-related medication complications in either cohort. CONCLUSION There was no decrease of in-hospital opioid usage when methadone was used with an ERAS protocol. Total opioid usage is correlated with hospital LOS following PSF.
International Journal of Spine Surgery, 2021
Robotic assistance in surgical procedures is a valuable tool that enhances the safety and efficac... more Robotic assistance in surgical procedures is a valuable tool that enhances the safety and efficacy of invasive surgeries. These devices are divided functionally into surgeon surrogates where the device operates under the direct control of an offsite surgeon, and surgeon adjuncts where the device is an intraoperative guidance tool used in a portion of the procedure. The current state of robotic spine surgery focuses on the latter, addressing the primary task of pedicle screw placement. We would like to share our experience with the Mazor Robotics devices to discuss the underlying concepts, strengths, weaknesses, and results as they pertain to pediatric spine deformity.
Journal of Neurosurgery: Pediatrics, 2021
OBJECTIVEPosterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) can be associate... more OBJECTIVEPosterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) can be associated with significant blood loss. It has been suggested that blood loss is greater in different racial groups. The purpose of this study was to evaluate differences in blood loss between African American and Caucasian patients undergoing PSF for AIS.METHODSA retrospective review was performed of patients aged 10–18 years with AIS who were treated with PSF from 2014 to 2017 at a single children’s healthcare system. Patient demographic, radiographic, and operative data were obtained from medical records. Intraoperative blood loss was calculated using the formula described by Waters et al. Patients who declined reporting their race or had prior spinal surgery, neuromuscular or syndromic diagnoses, a history of cardiac or thoracic surgery, or a bleeding disorder were excluded. Blood loss variables were log-transformed for normality and modeled using multivariable linear regression.RESULTSA tota...
Spine Deformity, 2021
PURPOSE Enhanced Recovery after Surgery (ERAS) pathways have been shown to decrease length of sta... more PURPOSE Enhanced Recovery after Surgery (ERAS) pathways have been shown to decrease length of stay (LOS) after posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). The aim of this study was to compare immediate post-operative outcomes following an ERAS pathway with a traditional pathway for AIS. METHODS A prospective dual-center study of patients treated using an ERAS pathway (203 patients) or a traditional discharge (TD) pathway (73 patients) was performed with focus on pain at discharge, quality of life at one month, and return to school/work. RESULTS LOS was 55% less in the ERAS group (4.8 days TD vs. 2.2 days ERAS, p < 0.001). Length of surgery (4.8 h TD vs. 2.8 h, p < 0.001) and EBL (500 cc vs. 240 cc, p < 0.001) were greater in the TD group, likely related to larger curve magnitudes ((62.0° TD vs. 54.0° ERAS, p < 0.001), a higher percentage of patients undergoing osteotomies (94% vs. 46%, p < 0.001) and more levels fused (11.4 ± 1.6 vs. 10.1 ± 2.6, p < 0.001) in the TD group. Regression analysis showed no difference in Visual Analog Score (VAS) score at discharge or quality of recovery using the QOR9 instrument between groups at follow up. There was no difference in return to school (p = 0.43) and parents' return to work (p = 0.61) between the groups. CONCLUSION Patients managed with an ERAS pathway had similar pain scores at discharge than those managed with a TD pathway. Both groups showed evidence of rapid return to normalcy by the first follow up visit.
Global Spine Journal, 2021
Study Design: Biomechanical Study. Objective: The search for optimal spinal alignment has led to ... more Study Design: Biomechanical Study. Objective: The search for optimal spinal alignment has led to the development of sophisticated formulas and software for preoperative planning. However, preoperative plans are not always appropriately executed since rod contouring during surgery is often subjective and estimated by the surgeon. We aimed to assess whether rods contoured to specific angles with a French rod bender using a template guide will be more accurate than rods contoured without a template. Methods: Ten experienced spine surgeons were requested to contour two 125 × 5.5 mm Ti64 rods to 40°, 60° and 80° without templates and then 2 more rods using 2D metallic templates with the same angles. Rod angles were then measured for accuracy and compared. Results: Average angles for rods bent without a template to 40°, 60° and 80° were 60.2°, 78.9° and 97.5°, respectively. Without a template, rods were overbent by a mean of 18.9°. When using templates of 40°, 60° and 80°, mean bend angle...
Journal of Bone and Joint Surgery, 2020
Background: Closed reduction and percutaneous pinning (CRPP) of supracondylar humeral fractures i... more Background: Closed reduction and percutaneous pinning (CRPP) of supracondylar humeral fractures is one of the most common procedures performed in pediatric orthopaedics. The use of full, standard preparation and draping with standard personal protective equipment (PPE) may not be necessary during this procedure. This is of particular interest in the current climate as we face unprecedented PPE shortages due to the current COVID-19 pandemic. Methods: This is a retrospective chart review of 1,270 patients treated with CRPP of a supracondylar humeral fracture at 2 metropolitan pediatric centers by 10 fellowship-trained pediatric orthopaedic surgeons. One surgeon in the group did not wear a mask when performing CRPP of supracondylar humeral fractures, and multiple surgeons in the group utilized a semisterile preparation technique (no sterile gown or drapes). Infectious outcomes were compared between 2 groups: full sterile preparation and semisterile preparation. We additionally analyzed a subgroup of patients who had semisterile preparation without surgeon mask use. Hospital cost data were used to estimate annual cost savings with the adoption of the semisterile technique. Results: In this study, 1,270 patients who underwent CRPP of a supracondylar humeral fracture and met inclusion criteria were identified. There were 3 deep infections (0.24%). These infections all occurred in the group using full sterile preparation and surgical masks. No clinically relevant pin-track infections were noted. There were no known surgeon occupational exposures to bodily fluid. It is estimated that national adoption of this technique in the United States could save between 18,612 and 22,162 gowns and masks with costs savings of 3.7millionto3.7 million to 3.7millionto4.4 million annually. Conclusions: We currently face critical shortages of PPE due to the COVID-19 pandemic. Data from this large series suggest that a semisterile technique during CRPP of supracondylar humeral fractures is a safe practice. We anticipate that this could preserve approximately 20,000 gowns and masks in the United States over the next year. Physicians are encouraged to reevaluate their daily practice to identify safe opportunities for resource preservation.
Prosthetics and Orthotics International, 2019
Journal of Spine Surgery, 2018
Background: Screw malpositioning is an identifiable cause of intraoperative neurophysiologic chan... more Background: Screw malpositioning is an identifiable cause of intraoperative neurophysiologic changes. Although triggered screw electromyography (t-EMG) has been found to exhibit high sensitivity for identifying malpositioned screws, no previous study has assessed the utility of combining t-EMG with robotic-assisted pedicle screw placement for identifying malpositioned screws. We sought to evaluate the utility of t-EMG used in combination with robotic-assisted pedicle screw placement for identifying malpositioned screws in patients with adolescent idiopathic scoliosis (AIS). Methods: Patients undergoing robotic-assisted posterior spinal fusion with pedicle screw fixation for AIS underwent retrospective review from a single surgeons prospectively collected database. Preoperative demographic data and curve characteristics were recorded. Computed tomography (CT) scans were reviewed, measuring pedicle width and classifying pedicle morphology using the channel classification system. Pedicle data was compared against intra-operative t-EMG data, with a minimal threshold of 8 mA used for screw removal and screw path examination and the rate of screw redirection recorded. All pedicle screws were verified using image intensification. Results: Forty-nine patients (11 males, 38 females, average age 14.49 years) with an average curve magnitude of 51 degrees and placement of 844 pedicle screws to attain an average curve correction of 67.7%. The incidence of an absent pedicle (type C or D morphology) was 2%. Overall, 24 screws (2.8%) were identified with an abnormal t-EMG threshold. All screws were found to have an intact medial wall upon probing and were reinserted without redirection. No patient or curve characteristic was predictive of abnormal t-EMG amplitude but smaller pedicles correlated with smaller amplitudes. Conclusions: With precise pre-operative planning, robotic-assisted pedicle screw placement has shown to be a safe and effective method in treating AIS patients as shown by the lack of medial pedicle breach and malpositioned screws. We found no evidence to support combined use of t-EMG for identifying medially malpositioned screws.
Spine Deformity, 2019
Background: Children with congenital heart disease (CHD) have been reported to be at increased ri... more Background: Children with congenital heart disease (CHD) have been reported to be at increased risk of developing scoliosis following cardiac surgery. Previous sample studies have reported that these patients may safely undergo posterior spinal fusion (PSF) with low complication rates. The goal of this study is to provide an updated analysis of the perioperative complication profile for posterior spinal fusion in a large cohort of pediatric patients with CHD, using a nationwide database. Methods: A retrospective cohort study was conducted using 30-day perioperative outcomes data from the NSQIP-P database. Our inclusion criteria were all pediatric patients who underwent posterior spinal fusion by CPT code. Patients were subdivided into two groups: those with a history of cardiac surgery for CHD and those without. Postoperative complications were classified according to the Clavien-Dindo system. Risk factors were assessed in univariate and multivariate logistic regression analyses, with significance set at p ! .05. Results: Our results included 3,426 pediatric patients (68.2% female, 31.8% male) with a median age at spinal fusion of 13.7 AE 2.87 years. A CHD diagnosis was present in 312 patients, with 128 having had prior cardiac surgery. The overall complication rate was 6.68%, with a 10.9% rate in the prior cardiac surgery cohort (p 5 .068). The most common overall perioperative complications were unplanned readmission (3.5%), reoperation (2.6%), and superficial wound dehiscence (2.5%). Patients with a history of cardiac surgery were not at increased risk for postoperative complications; however, blood transfusion (p ! .001), bronchopulmonary dysplasia (p ! .001), combined bronchopulmonary dysplasia and previous cardiac surgery (p 5 .004), and a neuromuscular diagnosis (p ! .001) were all risk factors for major postoperative complications in this cohort. Conclusions: Children with scoliosis who have undergone cardiac surgery to address CHD are not at an increased risk of perioperative complications within 30 days of undergoing a posterior spinal fusion. However, patients who underwent cardiac surgery for CHD who also had bronchopulmonary dysplasia or an associated neuromuscular diagnosis are at increased risk for perioperative complications. It is important for pediatric orthopedic spine surgeons to be familiar with an updated profile of potential perioperative obstacles they may face when treating these patients, as seen in a large and representative cohort.