Delayed neurologic injury due to bone graft migration into the spinal canal following scoliosis surgery.
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Bone Transplantation↗
Biomedical subjects
Sean D Early
Publications and source records attributed to Sean D Early.
The feasibility of anterior thoracoscopic spine surgery in children under 30 kilograms.
STUDY DESIGN: A retrospective comparison of pediatric patients weighing less than 30 kg who underwent thoracoscopic anterior spinal release and fusion for deformity correction. This group was compared to two control groups: patients weighing over 30 kg (thoracoscopic) and patients under 30 kg (open). OBJECTIVE: To determine the efficacy and safety of thoracoscopic anterior spinal release and fusion in small pediatric patients weighing less than 30 kg. SUMMARY OF BACKGROUND DATA: Recently, thoracoscopic methods have been utilized to perform anterior spinal release/fusion in the treatment of pediatric and adult spinal deformity. The safety, efficacy, and technical challenges of thoracoscopic spinal surgery in small children have not been established. METHODS: "Small thoracoscopic children," defined as those under 30 kg who had thoracoscopic spinal surgery, are the main focus of this study. They were compared to "large thoracoscopic children" (>30 kg, thoracoscopic surgery) and "small open children" (<30 kg, open surgery). Preoperative, intraoperative, and postoperative parameters were analyzed. RESULTS: Small thoracoscopic children (n = 33) had greater estimated blood loss/kg body weight (13.6 mL/kg vs. 6.2 mL/kg; P= 0.003), greater chest tube output (27.5 mL/kg vs. 17.1 mL/kg; P= 0.003), and a longer intensive care unit stay (4.2 days vs. 1.5 days; P= 0.001) than did large thoracoscopic children (n = 48). Conversion to an open thoracotomy occurred in one patient from each of the thoracoscopic groups. Small thoracoscopic children required more anesthesia preparation time (79.2 minutes vs. 64.2 minutes; P= 0.002) than the small open children (n = 25). There was no significant difference in estimated blood loss, chest tube output, or intensive care unit stay between these two groups. Additionally, no significant difference was found between the three groups with regard to the number of discs excised, operative time, and total hospital stay. CONCLUSION: Despite the decreased working space within the chest and difficulties of selective intubation, anterior thoracoscopic surgery for spinal release and fusion can be performed as safely in "small" children as in "large" children; however, additional intraoperative challenges should be anticipated. Although the outcomes were similar in the small thoracoscopic children compared to the small open children, the authors believe that very small patients (under 20 kg) should remain a relative contraindication to thoracoscopic surgery, especially during a surgeon's learning curve.
Adolescent↗
Back pain and backpacks in school children.
OBJECTIVE: Back pain in adults is common and well studied. In contrast, back pain in children has received comparatively little scientific study, despite recent media attention. The purpose of this study is to see what factors influence the prevalence of back pain in middle school children, with particular attention to the weight of children's backpacks and the availability of school lockers. METHODS: A population-based sample of 1540 children ages 11-14 years in a large metropolitan area was studied. A questionnaire was used to determine presence and severity of back pain, availability of lockers, backpack use, use of 1 or 2 straps to carry backpack, activity limitations due to back pain, and use of pain medication for back pain. Gender, age, weight of the child, and weight of his or her backpack were recorded. Results of scoliosis screening were evaluated with regard to the above information. Data were analyzed using the chi test and univariate or multivariate logistic regression analysis as appropriate. RESULTS: Overall, 37% of the children reported back pain. Backpacks were used by 97% of children, hence there were too few students not using backpacks to treat backpack use as an independent variable. Multivariate analysis found back pain associated with use of a heavier backpack (P=0.001), younger age (P<0.001), female sex (P<0.001), and a positive screening examination for scoliosis (P=0.009). Children with lockers available reported less back pain (P=0.016). The use of 1 or 2 straps to carry the backpack did not have a significant association with back pain (P=0.588). Of the children who reported back pain, 34% limited their activity due to the pain, 14% use medication for pain relief, and 82% believed their backpack either caused or worsened their pain. CONCLUSIONS: The incidence of back pain in early adolescence approaches that seen in adults. Recommendations for an "acceptable" weight of backpacks cannot be made from this study, as the weights of students' backpacks seem directly proportional to the likelihood of back pain. This study identifies 2 factors associated with self-reported back pain in early adolescents that are amenable to change: availability of school lockers and lighter backpacks. These findings may be useful in advising families and influencing school policies.
Adolescent↗
Childhood diskitis.
Childhood diskitis may occur in the thoracic, lumbar, or sacral spine and can affect children of all ages, but it is most common in the lumbar region in children younger than 5 years. Physical examination, laboratory tests, and radiologic studies all aid in the diagnosis of this clinical syndrome, and proper use can prevent unnecessary invasive intervention. Presentation varies with age; the child may refuse to bear weight on the lower extremities or may present with back pain, abdominal pain, a limp, or, if an infant or toddler, with irritability. The etiology appears to be a bacterial infection, usually caused by Staphylococcus aureus. Most children improve rapidly with a 4- to 6-week course of antibiotics. Although not routinely necessary, immobilization decreases symptoms and, in the case of osseous destruction, prevents progression of spinal deformity. Biopsy of the infected disk space is reserved for children refractory to intravenous antibiotics. Follow-up should include plain radiographs at regular intervals for 12 to 18 months to ensure resolution of the destructive process.
Anti-Bacterial Agents↗