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Biomedical subjects

Stuart L Weinstein

Publications and source records attributed to Stuart L Weinstein.

At least 19 recordsLinked to original sources
PubMed2006

Rare bilateral C6 spondylolysis and spondylolisthesis in an adolescent athlete: evaluation with magnetic resonance imaging and multidetector computerized tomography.

STUDY DESIGN: Case report. OBJECTIVE: To show a rare case of cervical spondylolysis and spondylolisthesis secondary to bilateral stress fractures at the pedicle laminar junction of C6 in a 16-year-old athlete playing high school baseball. SUMMARY OF BACKGROUND DATA: The patient presented with 3 months of neck pain and intermittent right arm radicular symptoms. METHODS: Plain radiographs and multidetector computerized tomography (CT) of the cervical spines. RESULTS: Plain radiographs revealed loss of lower cervical lordosis. Multidetector CT indicated bilateral C6 spondylolysis. Magnetic resonance imaging showed bilateral marrow edema at the pedicle laminar junction of C6. Treatment included placing his neck in a Philadelphia collar for 6 weeks. Follow-up CT revealed progression of healing. CONCLUSION: Early diagnosis and appropriate management of these cases are important to promote healing.

Adolescent↗
PubMed2006

The case for patient-centered care in orthopaedics.

Now is a critical time to develop a patient-centered care model in the field of orthopaedic surgery. Patient-centered care is defined by the American Academy of Orthopaedic Surgeons as the provision of safe, effective, and timely musculoskeletal care achieved through cooperation between the orthopaedic surgeon; an informed, respected patient (and family); and a coordinated health care team. Patient-centered care, a paradigm shift from disease-centered care, is being championed by government agencies, patient advocacy groups, and insurance companies. Orthopaedic organizations must develop a comprehensive education program to provide surgeons the tools they need to navigate this paradigm shift.

Adult↗
PubMed2006

Slipped capital femoral epiphysis: current concepts.

Slipped capital femoral epiphysis is a common hip disorder in adolescents, with an incidence of 0.2 (Japan) to 10 (United States) per 100,000. The etiology is unknown, but biomechanical and biochemical factors play an important role. Symptoms at presentation include pain in the groin, thigh, or knee. Ambulatory patients also may present with a limp. Nonambulatory patients present with excruciating pain. The slipped capital femoral epiphysis is classified as stable when the patient can walk and unstable when the patient cannot walk, even with the aid of crutches. Because the epiphysis slips posteriorly, it is best seen on lateral radiographs. The treatment of choice for stable slipped capital femoral epiphysis is single-screw fixation in situ. This method has a high probability of long-term success, with minimal risk of complications. In the patient with unstable slipped capital femoral epiphysis, urgent hip joint aspiration followed by closed reduction and single- or double-screw fixation provides the best environment for a satisfactory result, while minimizing the risk of complications.

Epiphyses↗
PubMed2005

Significant scoliosis regression following syringomyelia decompression: case report.

We present the case of a 5-year-old boy presenting with a 54-degree scoliosis secondary to a Chiari I malformation with a holocord syringomyelia extending from C1 to T10. Neurosurgical treatment involved posterior fossa craniectomy with decompression, and partial C1 laminectomy. At follow-up 7 years later, at age 12, radiographs revealed only a 4-degree scoliosis, and follow-up MRI revealed a deflated syrinx. We report this case to reveal the most significant scoliosis regression seen in our experience that may occur in younger patients after neurosurgical syringomyelia decompression for Chiari I hindbrain herniation.

Cervical Vertebrae↗
PubMed2004

Use of the Rosenberger brace in the treatment of progressive adolescent idiopathic scoliosis.

STUDY DESIGN: Retrospective chart review. OBJECTIVES: To evaluate the efficacy of the Rosenberger thoracic lumbar sacral orthosis in preventing curve progression in adolescent idiopathic scoliosis. SUMMARY OF BACKGROUND DATA: Radiographic outcomes of patients using the Rosenberger thoracic lumbar sacral orthosis have never been reported in the literature, but reports of other thoracic lumbar sacral orthoses conflict concerning the ability braces to improve on the natural history of adolescent idiopathic scoliosis. METHODS: Seventy-one patients with progressive adolescent idiopathic scoliosis treated with the Rosenberger were evaluated at an average of 2.3 years following brace discontinuation. Initial curves averaged 29 degrees. Braces were prescribed for 16 to 20 hours per day and worn for an average of 3.2 years. Patients were between 9 and 16 years of age, and all were skeletally immature at the time of bracing. RESULTS: Twenty-one patients (30%) underwent instrumentation and arthrodesis despite bracing. Forty (56%) had more than 5 degrees of progression. Overall, 43 (61%) had surgery and/or progressed by the time of follow-up. The average curve correction was 33% in patients who did not have surgery and 21% in those patients who did (P < 0.04). Other significant factors associated with brace failure included absence of menarche before treatment, younger age at presentation and initial bracing, increased apical rotation of the primary curve at presentation, and a thoracic curve pattern. CONCLUSIONS: The Rosenberger brace demonstrated an overall failure rate similar to untreated rates from published natural history studies, although subgroups of patients had lower failure rates. These findings suggest the need for further refinement of the indications for the Rosenberger brace.

Adolescent↗
PubMed2004

A prognostic model for the presence of neurogenic lesions in atypical idiopathic scoliosis.

STUDY DESIGN: Consecutive series of patients with idiopathic scoliosis with atypical features. OBJECTIVES: The purpose of this study is to define a specific yet sensitive set of signs and symptoms to indicate the use of MRI in patients with atypical idiopathic scoliosis. Specifically, this study empirically defines a new diagnostic test for the presence of neurogenic lesions based on clinical and radiologic data and then reports the properties of this test in relation to MRI as the gold standard. SUMMARY OF BACKGROUND DATA: The reported prevalence of brain stem and spinal cord abnormalities in patients with idiopathic scoliosis associated with atypical features varies from 0% to 60%. This wide range most likely results from the fact that the samples studied are either not well defined or are heterogeneous across studies. Because of these issues, the likelihood of neurogenic lesions in atypical idiopathic scoliosis is not known; consequently, the decision to order an MRI is controversial.METHODS A total of 1,206 patients coded as having idiopathic scoliosis were identified from our institutional database. Of these, 72 patients had one or more atypical features: early-onset scoliosis, atypical curve, severe curve despite immaturity (>45 degrees ), rapidly progressive curve (>1 degrees per month), back pain, headache, or neurologic abnormalities on clinical examination. All 72 patients underwent brain and spinal cord MRI. Logistic regression was used to determine significant predictors of positive MRI and to define the prognostic model. RESULTS: Eleven patients (15%) had abnormal findings on MRI. Eight had an Arnold-Chiari type I malformation associated with a syrinx; 1 had an Arnold-Chiari type I malformation; 1 a syrinx; and 1 a cervical syrinx with a conus lipoma. MRI was positive in 5 of 9 patients (55%) with severe curves despite immaturity. Twenty patients had one or more abnormal neurologic signs. Of these, 8 (40%) had a positive MRI, while only 3 of the 52 patients (6%) with a normal neurologic examination (but other atypical features) had a positive MRI. The most predictive model included the variables neurologic abnormalities (yes or no) and severe curve despite immaturity (yes or no). Using this model, patients with atypical characteristics other than severe curvatures or abnormal neurologic abnormalities(s) had a 3% probability (95% confidence interval [CI], 1-12%) of having a positive MRI; patients with abnormal neurologic change(s), but a nonsevere curve, had a 29% probability of a positive MRI (95% CI, 12-53%) and patients with severe curves and no neurologic change(s) had a 32% probability of positive MRI (95% CI, 8-71%). Patients with both a severe curve and abnormal neurologic change(s) had an 86% probability of positive MRI (95% CI, 46-98%). Agreement between this test and the MRI was 75%, with a sensitivity of 82% (95% CI, 48-97%) and a specificity of 74% (95% CI, 61-83%). CONCLUSIONS: The model derived in this study indicates that the probability of neurogenic lesions is extremely low in most patients with idiopathic scoliosis with atypical features. However, patients with severe curves despite skeletal immaturity and an abnormal neurologic examination have a significant probability of neurogenic lesions. Therefore, clinical efficiency will be enhanced by narrowing the indications for MRI to those patients with these risk factors.

Age of Onset↗
PubMed2004

Developmental hip dysplasia and dislocation: Part I.

A thorough knowledge of the normal growth and development of the hip, the causes of abnormal development, and the structural and functional changes that result from developmental hip dysplasia and dislocation provide needed information for treating these conditions. Ultrasonography, newborn screening, and radiographic evaluation are important diagnostic tools.

Adolescent↗
PubMed2004

Developmental hip dysplasia and dislocation: Part II.

Both nonsurgical and surgical options are available for the treatment of developmental hip dysplasia and dislocation. The advantages, pitfalls, and techniques for using the Pavlik harness should be thoroughly examined before treatment. Other closed and open treatments are aimed at concentric reduction and prevention of residual subluxation and dysplasia. Early diagnosis and treatment lead to the best long-term results for these conditions.

Braces↗
PubMed2003

Allelic variants of human melatonin 1A receptor in patients with familial adolescent idiopathic scoliosis.

STUDY DESIGN: A genetic study of patients with familial adolescent idiopathic scoliosis. OBJECTIVES: The purpose of this study was to evaluate the evidence for linkage on chromosome 4q and determine whether mutations in the gene coding for melatonin receptor are present. SUMMARY OF BACKGROUND DATA: Adolescent idiopathic scoliosis is the most common spine deformity arising during childhood, but its cause remains unknown. The fact that adolescent idiopathic scoliosis is often seen in several members of the same family strongly suggests a genetic factor. Recent work by Wise et al provides evidence for linkage of adolescent idiopathic scoliosis at several different chromosome sites, including 4q. In addition, there is some evidence that adolescent idiopathic scoliosis may be related to a disturbance in melatonin metabolism, and the human melatonin-1A receptor is known to be located on chromosome 4q. METHODS: Probands having clinically relevant idiopathic scoliosis (Cobb angle >30 degrees) and their relatives were identified. Radiographic confirmation was required for a positive diagnosis. Linkage analysis was performed with 15 microsatellite markers of chromosome 4q spaced at approximately 10-cM resolution and 5 microsatellite markers surrounding the site for human melatonin receptor. The gene for human melatonin receptor was screened for mutations in the coding region using genomic DNA samples by single-strand conformational polymorphism analysis. Amplimers showing a band shift were reamplified and sequenced bidirectionally. RESULTS: There was no evidence for linkage at chromosome 4q in this study population. Twenty-nine individuals demonstrated aberrant single-strand conformation polymorphism band patterns, and sequence evaluation demonstrated six genetic polymorphisms for the gene for human melatonin receptor. These genetic variations were found in both affected and nonaffected individuals, and there was no correlation between gene variants and the phenotype for adolescent idiopathic scoliosis. CONCLUSIONS: The results of this study demonstrated no evidence of linkage to chromosome 4q and no mutations in the coding region of the gene for human melatonin receptor. The identification of variants in the human melatonin receptor could provide a useful tool for testing the gene in the predisposition to various other melatonin-related disorders and for clarifying the role of melatonin in adolescent idiopathic scoliosis.

Adolescent↗
PubMed2003

Health and function of patients with untreated idiopathic scoliosis: a 50-year natural history study.

CONTEXT: Previous long-term studies of idiopathic scoliosis have included patients with other etiologies, leading to the erroneous conclusion that all types of idiopathic scoliosis inevitably end in disability. Late-onset idiopathic scoliosis (LIS) is a distinct entity with a unique natural history. OBJECTIVE: To present the outcomes related to health and function in untreated patients with LIS. DESIGN, SETTING, AND PATIENTS: Prospective natural history study performed at a midwestern university with outpatient evaluation of patients who presented between 1932 and 1948. At 50-year follow-up, which began in 1992, 117 untreated patients were compared with 62 age- and sex-matched volunteers. The patients' mean age was 66 years (range, 54-80 years). MAIN OUTCOME MEASURES: Mortality, back pain, pulmonary symptoms, general function, depression, and body image. RESULTS: The estimated probability of survival was approximately 0.55 (95% confidence interval [CI], 0.47-0.63) compared with 0.57 expected for the general population. There was no significant difference in the demographic characteristics of the 2 groups. Twenty-two (22%) of 98 patients complained of shortness of breath during everyday activities compared with 8 (15%) of 53 controls. An increased risk of shortness of breath was also associated with the combination of a Cobb angle greater than 80 degrees and a thoracic apex (adjusted odds ratio, 9.75; 95% CI, 1.15-82.98). Sixty-six (61%) of 109 patients reported chronic back pain compared with 22 (35%) of 62 controls (P =.003). However, of those with pain, 48 (68%) of 71 patients and 12 (71%) of 17 controls reported only little or moderate back pain. CONCLUSIONS: Untreated adults with LIS are productive and functional at a high level at 50-year follow-up. Untreated LIS causes little physical impairment other than back pain and cosmetic concerns.

Activities of Daily Living↗
PubMed2003

Developmental skeletal anomalies.

A genetic and molecular revolution is taking place in medicine today. Led by the Human Genome Project, genetic information and concepts are changing the way diseases are defined, diagnoses are made, and treatment strategies are developed. The profound implications of actually understanding the molecular abnormalities of many clinical problems are affecting virtually all medical and surgical disciplines. The ability to apply knowledge gleaned from the laboratory is our best hope for developing strategies to modify the pathologic effects of genes (by drug therapy), repair genes (gene therapy), and restore lost or affected tissues (tissue engineering). Instead of an empiric trial-and-error approach to therapy, it may become feasible to tailor treatment to the specific molecular malfunction. In this review we have chosen to emphasize a few selected musculoskeletal disorders, including skeletal dysplasias, spinal deformities, developmental dislocation of the hip, and idiopathic clubfoot. The logical extension of our understanding of the molecular players in many of these disorders is to establish precisely what the products of the affected genes do during skeletal development, and how mutations disturb these functions to produce the characteristic phenotype. Despite the many hypotheses generated from the work in human genetics, and the knowledge that has been gained from animal models, there remains a relatively poor understanding of how these genes interfere with skeletal development. Unraveling these mysteries and defining them in molecular and cellular terms will be the challenges for the near future.

Bone Diseases, Developmental↗