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John P Lubicky

Publications and source records attributed to John P Lubicky.

17 recordsLinked to original sources
PubMed2006

Superior odontoid migration in the Klippel-Feil patient.

Klippel-Feil syndrome (KFS) is an uncommon condition noted primarily as congenital fusion of two or more cervical vertebrae. Superior odontoid migration (SOM) has been noted in various skeletal deformities and entails an upward/vertical migration of the odontoid process into the foramen magnum with depression of the cranium. Excessive SOM could potentially threaten neurologic integrity. Risk factors associated with the amount of SOM in the KFS patient are based on conjecture and have not been addressed in the literature. Therefore, this study evaluated the presence and extent of SOM and the various risk factors and clinical manifestations associated therein in patients with KFS. Twenty-seven KFS patients with no prior history of surgical intervention of the cervical spine were included for a prospective radiographic and retrospective clinical review. Radiographically, McGregor's line was utilized to evaluate the degree of SOM. Anterior and posterior atlantodens intervals (AADI/PADI), number of fused segments (C1-T1), presence of occipitalization, classification-type, and lateral and coronal cervical alignments were also evaluated. Clinically, patient demographics and presence of cervical symptoms were assessed. Radiographic and clinical evaluations were conducted by two independent blinded observers. There were 8 males and 19 females with a mean age of 13.5 years at the time of radiographic and clinical assessment. An overall mean SOM of 5.0 mm (range = -1.0 to 19.0 mm) was noted. C2-C3 (74.1%) was the most commonly fused segment. A statistically significant difference was not found between the amount of SOM to age, sex-type, classification-type, AADI, PADI, and lateral cervical alignment (P > 0.05). A statistically significant greater amount of SOM was found as the number of fused segments increased (r = 0.589; P = 0.001) and if such levels included occipitalization (r = 0.616; P = 0.001). A statistically significant greater amount of SOM was also found with an increase in coronal cervical alignment (r = 0.413; P = 0.036). Linear regression modeling further supported these findings as the strongest predictive variables contributing to an increase in SOM. A 7.20 crude relative risk (RR) ratio [95% confidence interval (CI) = 1.05-49.18; risk differences (RD) = 0.52] was noted in contributing to a SOM greater than 4.5 mm if four or more segments were fused. Adjusting for coronal cervical alignment greater than 10 degrees , five or more fused segments were found to significantly increase the RR of a SOM greater than 4.5 mm (RR = 4.54; 95% CI = 1.07-19.50; RD = 0.48). The RR of a SOM greater than 4.5 mm was more pronounced in females (RR = 1.68; 95% CI = 0.45-6.25; RD = 0.17) than in males. Eight patients (29.6%) were symptomatic, of which symptoms in two of these patients stemmed from a traumatic event. However, a statistically significant difference was not found between the presence of symptoms to the amount of SOM and other exploratory variables (P > 0.05). A mean SOM of 5.0 mm was found in our series of KFS patients. In such patients, increases in the number of congenitally fused segments and in the degree of coronal cervical alignment were strongly associated risk factors contributing to an increase in SOM. Patients with four or greater congenitally fused segments had an approximately sevenfold increase in the RR in developing SOM greater than 4.5 mm. A higher RR of SOM more than 4.5 mm may be associated with sex-type. However, 4.5 mm or greater SOM is not synonymous with symptoms in this series. Furthermore, the presence of symptoms was not statistically correlated with the amount of SOM. The treating physician should be cognizant of such potential risk factors, which could also help to indicate the need for further advanced imaging studies in such patients. This study suggests that as motion segments diminish and coronal cervical alignment is altered, the odontoid orientation is located more superiorly, which may increase the risk of neurologic sequelae.

Adolescent↗
PubMed2006

Classification of congenitally fused cervical patterns in Klippel-Feil patients: epidemiology and role in the development of cervical spine-related symptoms.

STUDY DESIGN: A retrospective cohort and series review. OBJECTIVES: To determine the role of cervical spine fusion patterns on the development of cervical spine-related symptoms (CSS) in patients with Klippel-Feil syndrome (KFS) and evaluate age- and time-dependent factors that may contribute to fused cervical patterns and the development of the CSS. SUMMARY OF BACKGROUND DATA: Although the "hallmark" of KFS is the presence of congenitally fused cervical vertebrae, the epidemiology and role of specific cervical fused patterns are limited. In addition, the incidence of symptoms and various age- and time-dependent factors that are directly attributed to the congenitally fused cervical segments in KFS patients is unknown. METHODS: A radiographic and clinical review of 28 KFS patients at a single institution. Radiographically, Type I patients were defined as having a single congenitally fused cervical segment. Type II patients demonstrated multiple noncontiguous, congenitally fused segments, and Type III patients had multiple contiguous, congenitally fused cervical segments. Clinical records were reviewed for patient demographics, presence and type of symptoms, and clinical course. RESULTS: Twelve males and 16 females were reviewed for clinical follow-up (mean, 8.5 years) and radiographic assessment (mean, 8.0 years). The mean age at presentation was 7.1 years; mean age of onset of CSS was 11.9 years. Clinically, 64% had no complaints referable to their cervical spine. Radiographically, 25%, 50%, and 25% were Type I, Type II, and Type III, respectively. At final clinical follow-up, 2 patients were myelopathic (Type II and Type III) and 2 were radiculopathic (Type II and Type III). Type III patients were largely asymptomatic but were associated with the highest risk in developing radiculopathy or myelopathy than Type I or Type II patients. Axial symptoms were predominantly associated with Type I patients. Myelopathic patients developed initial CSS earlier (meanage, 10.6 years) than patients with predominant axial (mean age, 13.0 years) or radiculopathic symptoms (mean age, 18.6 years) (P > 0.05). Patients with radiculopathy or myelopathy were diagnosed at a mean age of 17.9 years. Type I patients were predominantly females, while males were largely Type III. Surgery entailed 11% of patients, composed of 2 myelopathic patients (Type II and Type III) and 1 radiculopathic patient (Type II). CONCLUSIONS: In our review, 36% of KFS patients had CSS and the majority had axial symptoms. Axial neck symptoms were highly associated with Type I patients, whereas predominant radicular and myelopathic symptoms occurred in Type II and Type III patients. This classification system has promise for early detection for CSS. Activity modification should be stressed in KFS patients at high risk for neurologic compromise.

Adolescent↗
PubMed2006

Symptomatic cervical disc herniation in a pediatric Klippel-Feil patient: the risk of neural injury associated with extensive congenitally fused vertebrae and a hypermobile segment.

STUDY DESIGN: A case report. OBJECTIVE: To report the occurrence of a herniated cervical disc following a high-impact activity in a pediatric Klippel-Feil patient who presented with spinal cord compression, myelopathy, and myelomalacia requiring posterior instrumented fusion followed by an anterior discectomy and fusion at the hypermobile nonfused segment. SUMMARY OF BACKGROUND DATA: The primary hallmark of Klippel-Feil syndrome (KFS) is the presence of at least one congenitally fused cervical segment. Studies have reported the potential risk of cervical injury from hypermobility associated with the nonfused cervical segment in KFS. The manifestation of a cervical disc herniation in the pediatric KFS patient is rare. To the authors' knowledge, the development of a symptomatic cervical herniated disc attributed to mechanical fatigue following a high-impact activity has not been addressed in the literature with respect to the pediatric KFS patient having extensive cervical fusion and a hypermobile segment. METHODS: A 16.8-year-old KFS boy with occipitalization of C1 and fusion of C2-C3 and C4-T1 presented with myelopathy, severe cord compression, and myelomalacia stemming from a left-sided herniated cervical disc at C3-C4 with onset following an 8-foot high rooftop jump. On radiographic evaluation, the patient's C3-C4 segment was hypermobile. RESULTS: The patient was operatively managed via a same-day combined posterior-anterior procedure. The posterior aspect of the procedure entailed a posterior lateral mass plate-screw fixation at C3-C4 with autologous iliac crest bone fusion. Anteriorly, a discectomy was performed at C3-C4 with application of an interbody tricortical autograft. After surgery, the patient wore a halo vest for 3 months, followed by a soft collar for an additional 3 months. On final follow-up at 39 months, the patient was asymptomatic with no instrumentation-related complications, fusion of the posterior graft-bed and anterior interbody graft was noted, and cervical alignment was maintained. CONCLUSIONS: A hypermobile segment in the pediatric KFS patient is a risk factor that may lead to cord compression. A symptomatic herniated cervical disc may develop from an excessive mechanical load stress in a pediatric KFS patient with multiple fused segments. In such a patient, a same-day combined posterior-anterior procedure provides cord decompression and stabilizes the spine with a favorable outcome.

Adolescent↗
PubMed2006

Radiographic assessment of segmental motion at the atlantoaxial junction in the Klippel-Feil patient.

STUDY DESIGN: A retrospective review of 33 consecutive Klippel-Feil syndrome (KFS) patients at a single institution. OBJECTIVES: To assess in KFS patients the presence and degree of radiographic segmental motion at the atlantoaxial junction, factors contributing to such motion, and associated clinical manifestations. SUMMARY OF BACKGROUND DATA: Studies suggest that abnormal segmentation in KFS patients may result in cervical hypermobility, increasing the risk of developing neurologic compromise and the need for surgical intervention. The use of the anterior and posterior atlantodens interval (AADI/PADI) has gained interest as a method for assessing atlantoaxial instability and for space available for the cord. Although helpful for identifying instability after trauma, these measurements are not understood in KFS patients. In addition, the effects of the fusion process associated with KFS on atlantoaxial motion and associated clinical findings have not been properly addressed. METHODS: Radiographs were analyzed for the presence of occipitalization, number/location of congenitally fused segments, and the AADI and PADI. RESULTS: There were 15 males and 18 females (mean age, 13.9 years). Occipitalization occurred in 48.5% of patients. A fused C2-C3 segment was noted in 72.7% of cases. More motion with respect to AADI was evident on O-C1 and C2-C3 fusion only patients, which were all asymptomatic. Overall, 24.2% of patients were symptomatic. Mean AADI and PADI difference was 2.0 mm (symptomatic: mean, 1.5 mm; asymptomatic: mean, 2.1 mm) and -1.7 mm (symptomatic: mean, -1.0 mm; asymptomatic: mean, -2.0 mm), respectively (P > 0.05). CONCLUSIONS: Hypermobility of the atlantoaxial junction, as indicated by increased AADI on flexion-extension radiographs, is not necessarily associated with an increased risk for the development of symptoms or neurologic signs in the KFS patient. Occipitalization plays an integral role in the degree of motion at the atlantoaxial region. Greatest AADI values were in patients with occipitalization and a fused C2-C3 segment. The presence of symptoms was not related to the degree of AADI change. Evaluation of the PADI provides additional information for identifying patients at risk for developing symptoms. Nonetheless, KFS patients remain largely asymptomatic.

Adolescent↗
PubMed2005

The superior mesenteric artery syndrome in patients with spinal deformity.

STUDY DESIGN: A retrospective review. OBJECTIVE: To determine the incidence of the superior mesenteric artery syndrome (SMAS) after surgical correction for scoliosis and if it is influenced by newer derotation/translation surgical systems. SUMMARY OF BACKGROUND DATA: The SMAS is a known complication after surgery. METHOD: Of 2939 charts reviewed, 17 patients between 1960 and 2002 matched inclusion criteria. RESULTS: Our incidence of the SMAS was 0.5%. Onset of symptoms was 7.2 days. Several scoliosis diagnoses were included in the study group. Instrumentation that was used included: nondistraction systems (n = 14), Harrington rod with body cast (n = 1), Luque rod with sublaminar wires (n = 1), and casted in situ posterior spinal fusion (n = 1). Before surgery, 10 of 17 patients weighed less than the 50th percentile. Mean preoperative BMI was 18.6 kg/cm/cm. Postoperative height gain averaged 3.175 cm, and weight loss at onset of symptoms averaged 4.5 kg. There were 14 patients who required nasogastric suction for an average duration of 10.2 days, 11 required hyperalimentation, and 5 concurrently received hyperalimentation with enteric feeding. The SMAS recurred in 2 patients. CONCLUSIONS: Postoperative weight loss appears to be more important for the development of the SMAS than asthenic body type. Newer derotation/translation corrective techniques have not eliminated the SMAS. Gastrointestinal imaging is indicated when nausea and vomiting occur 6-12 days after surgery, associated with early satiety and normal bowel sounds. Decompression and nutritional support remain the mainstays of treatment.

Adolescent↗
PubMed2005

Point of view.

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Bone Cements↗
PubMed2005

Unusual spondylolisthesis.

STUDY DESIGN: Literature and personal experience review of the topic of unusual spondylolisthesis OBJECTIVE: To provide information to the readership on the association of spondylolisthesis with syndromic and other conditions and implications of, indications for, and details of treatment for the spondylolisthesis. SUMMARY OF BACKGROUND DATA: From personal experience and perusal of the literature, it is known that spondylolysis/spondylolisthesis is frequently associated with various conditions with musculoskeletal abnormalities as part of their overall presentation A formal literature search revealed a number of these conditions. The underlying conditions often have a significant effect or can even be the cause of the spondylolisthesis. In light of this, there needs to be a high index of suspicion when evaluating such patients to identify this spinal deformity, if it is present so that appropriate treatment can be rendered early, before severe deformity and disability occur as indicated. METHODS: A literature search was performed using search engines. RESULTS: The reader has been provided with discussions about a number of conditions with associated spondylolisthesis. CONCLUSION: A number of generalized conditions have as part of their presentation spondylolysis/spondylolisthesis, which should be identified as part of their initial and ongoing evaluations.

Humans↗
PubMed2003

Complications related to postoperative casting after surgical treatment of subluxed/dislocated hips in patients with cerebral palsy.

Three hundred sixteen subluxed/dislocated hips (222 patients) underwent upper femoral osteotomy. Of these, 286 (90.5%) hips were casted (average patient age: 8.9 years) and 30 (9.5%) were not (average patient age: 13.6 years). Average follow-up was 4.7 years. Complications in the casted/noncasted groups (per hip) were: 43/0 (15%/0%) skin sores; 11/1 (3.8%/3.3%) wound infections; 6/0 (2.1%/0%) instrumentation failures; 22/1 (7.7%/3.3%) reoperations; and 13/1 (4.5%/3.3%) rehospitalizations. Differences between the groups were not statistically significant. Casted patients were younger and more neurologically involved. Casting is useful to ensure healing of osteotomies, prevent instrumentation failure and injury to the operated legs, and allow for ease of handling. Complications that occurred were managed and had no long-term sequelae.

Adolescent↗
PubMed2002

Issues in surgical treatment of thoraco-lumbar injuries associated with spinal cord injuries in children and adolescents.

To evaluate standards of care in surgical treatment of thoracolumbar injuries (TLIs), we reviewed the cases of 79 surgically treated patients (39 males, 36 females) with TLIs and spinal cord injuries occurring from January 1985 to January 2000. We assessed radiographs of fracture-dislocation reductions; restorations of sagittal and coronal alignment of injured segments; instrumentation levels and strategies; operations, and reoperations. Mean age at time o f injury was 14.1 years. The majority of injuries were thoracic, and posterior spinal fusion with instrumentation was the most common index procedure performed. Mean follow-up was 23.4months. Reoperation rate was 20%. Problems in achieving fracture reduction, selecting correct instrumentation levels, restoring proper sagittal alignment, an d planning a nd performing surgeries were more prevalent in patients treated before 1990 but are still problematic, even with use of modern segmental instrumentation, and frequently require revision to improve function or relieve symptoms. These results indicate a wide range in standards of care in surgical treatment of TLIs.

Adolescent↗
PubMedDate not supplied

Musculoskeletal manifestations of Russell-Silver syndrome.

The musculoskeletal manifestations of Russell-Silver syndrome were studied in 25 patients. The most common manifestations were short stature (25 patients), limb-length discrepancy (23 patients), clinodactyly (19 patients) metacarpal bone and phalangeal abnormalities (13 patients), scoliosis (9 patients), foot syndactylism (5 patients), and developmental dysplasia of the hips (3 patients). Five patients underwent lower extremity limb-lengthening procedures for discrepancies greater than 3 cm and three patients had successful pelvic and/or femoral osteotomies for hip dysplasia. All 18 patients studied had retardation of bone age, which peaked at age 7 years.

Abnormalities, Multiple↗