Journal of Pediatric Orthopaedics最新文献

{"title":"Retrospective Analysis and Characterization of Avascular Necrosis By Bone Location in Pediatric Leukemia/Lymphoma Patients.","authors":"Amin Alayleh, Hiba Naz, Vanessa Taylor, Taylor R Johnson, Saima Farook, Grady Hofmann, Chiamaka Obilo, Nicole S Pham, Kathryn Harbacheck, Tara Laureano, Stephanie M Smith, Karen Chao, Stuart B Goodman, Kevin G Shea","doi":"10.1097/BPO.0000000000002963","DOIUrl":"10.1097/BPO.0000000000002963","url":null,"abstract":"<p><strong>Background: </strong>Avascular necrosis (AVN) is a serious complication of high-dose steroid therapy for pediatric patients with leukemia/lymphoma. AVN affects multiple bones and joints, leading to significant pain in different bone regions, early-onset osteoarthritis, and early joint replacement. Early detection and intervention for AVN may prevent pain and progressive joint collapse. The purpose of this study is to evaluate and characterize the specific AVN locations in a cohort of pediatric and adolescent patients with leukemia/lymphoma using the newly developed Bone Location for AVN from STeroids (BLAST) classification system that considers epiphyseal, metaphyseal, and diaphyseal locations in long bones.</p><p><strong>Methods: </strong>An imaging database was queried for patients 25 years old and younger with a diagnosis of AVN and leukemia/lymphoma who required steroid treatment. Patient MRIs were reviewed, and AVN sites were classified using the BLAST system. AVN locations were described using descriptive statistics. Multivariable logistic regression analysis was used to assess the odds of AVN bilaterality based on location.</p><p><strong>Results: </strong>A total of 84 patients (49/35 males/females) with acute lymphoblastic leukemia (ALL) (B-cell 74%, T-cell 21%) or acute myeloid leukemia (5%) were included in this cohort. The median age was 14.8 years at leukemia diagnosis and 16.5 years at AVN diagnosis. Most AVN locations include the femur (87%), tibia (68%), and humerus (25%). On the basis of the BLAST classification, the most common sites of AVN overall include the proximal tibial metaphysis (61%), distal femoral metaphysis (60%) and epiphysis (60%), and femoral head epiphysis (50%). The most common sites of AVN in the tibia, humerus, and femur are proximal tibial metaphysis (89%), humeral head epiphysis (86%), and distal femoral metaphysis (68%) and epiphysis (68%), respectively.</p><p><strong>Conclusions: </strong>This analysis demonstrates that AVN in leukemia/lymphoma patients on steroid therapy has a clear predilection for specific locations in long bones. Using the BLAST classification, practitioners are better equipped to characterize the location of AVN, monitor high-risk locations for joint collapse, and track early outcomes of preventative treatment. The development of prospective multicenter AVN study groups and screening protocols for early detection will be critical to improve functional outcomes and joint preservation for leukemia/lymphoma survivors and all other patients taking high-dose steroids.</p><p><strong>Level of evidence: </strong>Level II-retrospective cohort study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e641-e647"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144027582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does Vertebral Body Tethering Cause Coronal Hypermobility at Adjacent Noninstrumented Levels? A Preliminary Study.","authors":"Hans K Nugraha, Todd A Milbrandt, A Noelle Larson","doi":"10.1097/BPO.0000000000002959","DOIUrl":"10.1097/BPO.0000000000002959","url":null,"abstract":"<p><strong>Background: </strong>Fusion into the lumbar spine with lower instrumented vertebra (LIV) of L2 and below can result in increased mobility or hypermobility of the unfused segments, potentially contributing to early disk and joint wear and subsequent degenerative arthritis. Vertebral body tethering (VBT) is a motion-preserving surgery for scoliosis, but no data is available about its effect on disk motion for the uninstrumented segments distal to the LIV. We hypothesize that VBT preserves the coronal arc of motion distal to the LIV in AIS patients without the development of hypermobility which has been observed following fusion surgery.</p><p><strong>Methods: </strong>A single-center retrospective review was completed of adolescent idiopathic scoliosis patients who underwent VBT. Standing bending films were collected as standard of care preoperatively and at 1-year postoperatively with maximum effort on side bending according to an institutional protocol. To evaluate the coronal arc of motion, radiographic measurement of the intervertebral angles was measured at each level from the disk directly distal to LIV-S1, as described in previous literature.</p><p><strong>Results: </strong>A total of 95 patients had clinical preoperative and postoperative bending radiographs and were included in the study. In total, there were 2086 segments measured. Sixteen patients had bilateral tether procedures and were analyzed separately. Compared with preoperative values over the same levels, paired t test showed no significant difference in the coronal arc of motion for the distal uninstrumented segments.</p><p><strong>Conclusions: </strong>Normal segmental motion on lateral bend was preserved on the noninstrumented segments following VBT. In contrast to fusion, there was no evidence of lumbar hypermobility following VBT in scoliosis patients. This provides early evidence for preserved normal motion which could be protective against adjacent segment disease and early arthritis reported with long fusions.</p><p><strong>Level of evidence: </strong>Level III-retrospective cohort study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"376-383"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144326033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pathway for the Differential Diagnosis of Obstetrical Brachial Plexus Palsy.","authors":"Kyoko Okuno, Hidehiko Kawabata, Daisuke Tamura, Chikahisa Higuchi","doi":"10.1097/BPO.0000000000002957","DOIUrl":"10.1097/BPO.0000000000002957","url":null,"abstract":"<p><strong>Background: </strong>Obstetrical brachial plexus palsy (OBPP) is a common birth injury, generally presenting as upper limb paralysis at birth. While diagnosis is straightforward when associated with known risk factors, misdiagnoses can nevertheless occur. This study aimed to elucidate the process of differential diagnosis for OBPP by analyzing cases of suspected OBPP, ultimately diagnosed with other conditions.</p><p><strong>Methods: </strong>We reviewed the electronic medical records of patients under 1 year of age presenting with suspected or previously diagnosed OBPP at 2 tertiary childrens' centers in Osaka between 1994 and 2021. Cases were divided into the OBPP and non-OBPP groups, according to the final diagnosis, for comparison of demographic data and physical findings, to determine the clinical course that could be used to differentiate non-OBPP from OBPP.</p><p><strong>Results: </strong>Of the 414 enrolled cases, 387 (93%) were confirmed as OBPP, while 27 (7%) were diagnosed with other conditions. Statistically significant differences were found in gestational age, birth weight, and age of first visit, between the 2 groups, although these were not clinically meaningful for differential diagnosis. Shoulder dystocia was observed in 54% of OBPP cases, but not in non-OBPP cases. The key characteristics of OBPP included paralysis from birth, paralysis following an anatomic distribution, and paralysis that gradually improved without worsening. Conversely, joint contracture immediately after birth was a key indicator for ruling out OBPP. Using these criteria, 24 of 27 suspected cases were excluded from OBPP diagnosis. Of the remaining 3 cases, spinal cord infarction was detected on MRI in 1 case. In the remaining 2 cases, although normal MRI and surgical findings could rule out OBPP, a definite diagnosis could not be made.</p><p><strong>Conclusions: </strong>This study highlights that accurate OBPP diagnosis requires careful verification of specific characteristics. If these characteristics are not met, OBPP becomes less likely, and diagnostic uncertainty persists. An MRI of the brachial plexus is needed in such cases.</p><p><strong>Level of evidence: </strong>Level III-retrospective cohort study.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e637-e640"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12233166/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Risks and Benefits of Definitive Surgery in the Graduation of Idiopathic Early-Onset Scoliosis (I-EOS) Patients Whose Deformities Were Managed With Growing Rods: A Comparison With Matched Adolescent Idiopathic Scoliosis (AIS) Patients.","authors":"Gokay Dursun, Rafik Ramazanov, Halil G Demirkiran, Mehmet Ayvaz, Muharrem Yazici","doi":"10.1097/BPO.0000000000002966","DOIUrl":"10.1097/BPO.0000000000002966","url":null,"abstract":"<p><strong>Background: </strong>Growing rod treatment (GR) is one of the most popular methods for idiopathic EOS and is usually followed by posterior instrumented spinal fusion (PISF), which is also called graduation. Graduation surgery is technically demanding and complicated, leading to a tendency to avoid definitive fusion when there is an adequate improvement in scoliosis angle, no implant failure, and no need to change the instrumentation level. The aim of the present study was to compare the risks and benefits of PISF between patients with adolescent idiopathic scoliosis (AIS) treated with standard PISF against those with idiopathic EOS treated with GR and graduated with PISF.</p><p><strong>Methods: </strong>The study included patients with I-EOS who were treated with dual GR and PISF, and those with AIS who underwent standard PISF with AIS during the study period. The AIS and EOS groups were matched in terms of scoliosis curve magnitude, T2-T12 kyphosis, L1-S1 lordosis, sex, and age variables by propensity score matching.</p><p><strong>Results: </strong>Seven hundred seventy-six patients (24 EOS and 752 AIS) were included in the study. Seventy-two AIS patients were matched against 24 EOS patients. Statistically significant differences were found between the groups in terms of scoliosis correction percentage, surgical time, transfusion need, and number of instrumented segments. However, the percentage of T1-T12 length increase, percentage of T1-S1 length increase, instrumented spinal segment length increase, and the estimated blood loss were similar between the groups.</p><p><strong>Conclusion: </strong>Although the EOS group had longer surgical time (30 min longer), more bleeding (75 cc more), and less correction of the coronal deformity, trunk height gained by definitive surgery was the same as that in the AIS group. There was a difference in favor of AIS between the groups in terms of coronal deformity correction rates, but the final deformity size in the EOS patients was clinically insignificant (22±13 degrees). Definitive fusion in EOS with idiopathic etiology does not carry an excessive risk for complications, and the gains obtained by the patients after surgery are comparable to AIS patients who underwent PISF surgery.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"364-369"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143729917","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peripheral Nerve Injury Following Tibial Osteotomy in Children. Is There a Role for Routine Prophylactic Common Peroneal Nerve Decompression?","authors":"Nisarg Mehta, Stewart Morrison, Chris Harris, Lucas Annabell, Leo Donnan","doi":"10.1097/BPO.0000000000002969","DOIUrl":"10.1097/BPO.0000000000002969","url":null,"abstract":"<p><strong>Aims: </strong>To evaluate the long-term clinical outcomes and risk factors for nerve injury in children undergoing tibial osteotomy for lengthening and/or deformity correction at a tertiary pediatric center, focusing on common peroneal and tibial nerve injuries.</p><p><strong>Methods: </strong>This retrospective study included all children under 18 years of age who underwent tibial osteotomy over a 7-year period, excluding those with neuromuscular conditions. The primary outcome was peripheral nerve injury, while secondary outcomes included early unplanned return to theatre and deformity parameters.</p><p><strong>Results: </strong>A total of 173 tibial osteotomies were performed on 135 children, 80 of which were for tibial lengthening. Peripheral nerve injuries occurred in 11 cases (6.3%), with 81% showing complete (45%) or partial recovery (36%). Among patients undergoing tibial lengthening, the prevalence of nerve injury was 3.5%. Significant risk factors for nerve injury included multiple osteotomies ( P =0.02, RR: 1.30) and acute correction of valgus deformities ( P =0.01, RR: 1.35).</p><p><strong>Conclusion: </strong>The overall prevalence of nerve injury was 6.3% for all osteotomies and 3.5% in those undergoing tibial lengthening, with an 81% recovery rate. The rate of early unplanned return to the theatre was low at 3.4%. Prophylactic decompression of the common peroneal nerve should be considered for double-level osteotomies and acute correction of valgus deformity but is not routinely required during standard tibial lengthening. The potential risk of nerve injury should be discussed with the families as part of shared decision-making.</p><p><strong>Level of evidence: </strong>Level IV.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"390-395"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143795662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric Lateral Condyle Fractures With Elbow Dislocation: Revisiting the Song Classification of the Most Severe Injuries.","authors":"Andreas Rehm, Felix Morriss, Luke Granger, Rebecca J Worley, Helen E Chase, Elizabeth Ashby","doi":"10.1097/BPO.0000000000002990","DOIUrl":"10.1097/BPO.0000000000002990","url":null,"abstract":"","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e653-e654"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143978058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Public Insurance Status is Associated With Lower Bracing Treatment Success in Infants With Developmental Dysplasia of the Hip.","authors":"Jayna Lenders, Pranav Rajaram, Brandon W Henry, Alex L Gornitzky, Ying Li","doi":"10.1097/BPO.0000000000002925","DOIUrl":"10.1097/BPO.0000000000002925","url":null,"abstract":"<p><strong>Background: </strong>Early diagnosis and initiation of bracing for developmental dysplasia of the hip (DDH) can result in disease resolution. Bracing failure or late presentation necessitates surgical intervention. Socioeconomic factors can contribute to delayed diagnosis requiring more invasive treatment. Our purpose was to evaluate whether measures of health disparities are associated with bracing outcomes and treatment progression in children with DDH.</p><p><strong>Methods: </strong>Patients screened for DDH in a pediatric orthopaedic clinic at a single academic children's hospital between January 2013 and December 2021 were retrospectively reviewed. Demographics, state Area Deprivation Index (ADI; decile from 1 to 10 with a higher number indicating greater socioeconomic disadvantage), distance from a primary residence to the clinic, insurance type, >1 no-show appointments, and treatment course were collected.</p><p><strong>Results: </strong>Four hundred one patients received a diagnosis of DDH and were included in the analysis. The median age at presentation was 46 days and the median state ADI was 4. Two hundred ninety-six patients (73.8%) had resolution of DDH with bracing (Pavlik harness, abduction brace, or both), 77 (19.2%) underwent surgery, and 28 (7.0%) were lost to follow-up. Compared with patients with ADI 1 to 4, patients with ADI 5 to 10 were significantly more likely to have public insurance ( P <0.001) and >1 no-show appointment ( P <0.001). Higher socioeconomic disadvantage was associated with a greater proportion of patients requiring treatment progression (ie, failed bracing and need for surgery) or loss to follow-up ( P <0.001). Regressions controlling for sex, race, state ADI, distance from residence to clinic, and insurance type revealed that public insurance was predictive of age >6 months at presentation ( P <0.001), greater treatment progression ( P <0.001), and higher need for surgery ( P =0.001). Public insurance was a negative predictor of successful bracing treatment ( P <0.001).</p><p><strong>Conclusion: </strong>Our study showed that children with DDH and public insurance were older at initial presentation and had a higher likelihood of bracing failure necessitating more invasive treatment. Public insurance may be the most significant measure of health disparities in assessing which DDH patients are at risk for conservative treatment failure and would benefit from early social work support.</p><p><strong>Level of evidence: </strong>Level III-therapeutic.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"e599-e605"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144012880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functional and Cosmetic Outcome of Unipolar Release of Congenital Muscular Torticollis in Children Above 1 Year.","authors":"K C Saugat, Yam P Gurung, Tarun Rajbhandary, Ashok K Banskota, Bibek Banskota","doi":"10.1097/BPO.0000000000002972","DOIUrl":"10.1097/BPO.0000000000002972","url":null,"abstract":"<p><strong>Background: </strong>Congenital muscular torticollis (CMT) is a common congenital musculoskeletal anomaly where the affected sternocleidomastoid, surrounding soft tissues, and platysma progressively shorten causing ipsilateral head tilt and contralateral chin rotation. If untreated it may lead to permanent disfiguration of the neck and face. Unipolar release surgery is a convenient procedure without the risk of the spinal accessory nerve. Our study aims to report the functional and cosmetic outcomes of unipolar release surgery in children above 1 year.</p><p><strong>Methods: </strong>Twenty-nine patients who underwent distal unipolar release surgery from 2016 to 2023 were included. Preoperative functional scores: limitation of range of motion, head tilt, and facial asymmetry were compared with postoperative functional scores in the latest follow-up. Cosmetic score: scar, loss of column, and lateral band were postoperatively assessed in the latest follow-up. Lee and Kang scoring system was used.</p><p><strong>Results: </strong>The study participants had a mean age of 9.3±3.3 years with a mean follow-up of 3.5 years with 18 (63%) right-side and 11(38) left-side cases. Preoperative lateral rotation limitation was found to be poor in 11, fair in 15, and good in 3 cases, which progressed to good in 12 and excellent in 17 cases. The preoperative head tilt was found to be poor in 11, fair in 17, and good in 1 case, which after surgery was found to be good in 15 cases and excellent in 14 cases. Preoperative facial asymmetry cases were poor in 12 cases, fair in 16 cases, and good in 1 case, which postoperatively improved to 3 poor, 21 fair, and 5 good cases. Similarly, 21 (72%) cases had excellent scars and no loss of column.</p><p><strong>Conclusion: </strong>Unipolar release surgery has a favorable outcome in all our cases. All preoperative functional scores improved at our final follow-up and was statistically significant. Cosmetic outcome was also favorable.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":"45 7","pages":"438-444"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144591516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Shilla Growth Guidance Surgery for Early Onset Scoliosis: Predictors of Optimal Versus Suboptimal Performers.","authors":"William ElNemer, Myung-Jin Cha, Gregory Benes, Lindsay Andras, Behrooz A Akbarnia, David Bumpass, Scott Luhmann, Richard McCarthy, Paul D Sponseller","doi":"10.1097/BPO.0000000000002967","DOIUrl":"10.1097/BPO.0000000000002967","url":null,"abstract":"<p><strong>Background: </strong>The Shilla Growth Guidance surgery (SGGS) aims to correct a child's spinal deformity while allowing continued spinal growth. Our study used a multicenter early-onset-scoliosis database to determine significant predictors of best candidates.</p><p><strong>Methods: </strong>The Pediatric Spine Study Group multicenter database was analyzed for all patients who had undergone SGGS and had a minimum follow-up of 2 years. Patients without radiographic measurements preoperatively, postoperatively, and at the latest follow-up, as well as patients with myelo gibbus deformities, were excluded. These radiographs were evaluated for major curve, spinal length, and other parameters. Multivariate regressions were conducted to assess the effects of these parameters on the following 4 outcomes: (1) percent of initial curve correction, (2) scoliosis curve progression after surgery per year, (3) at least 1 unplanned SGGS-related reoperation, and (4) T1-S1 height change per year from 1st postoperative erect to final available follow-up.</p><p><strong>Results: </strong>Included were 105 children; the average follow-up was 4.8±2.4 years. Scoliosis etiologies included neuromuscular (n=36; 34%), syndromic (n=31; 30%), idiopathic (n=30; 29%), and congenital (n=8; 8%). Average preoperative, 1st postoperative erect, and latest follow-up major curves measured 69, 32, and 49 degrees, respectively. Average T1-S1 postoperative height change per year was 7±9 mm and average overall T1-S1 height change was 24±35 mm. Forty-eight (46%) patients had C-shaped and 57 (54%) had S-shaped curves; 59 (56%) patients underwent ≥1 SGGS-related reoperation. Multivariate Cox-proportional hazard test revealed younger age at index surgery [hazard ratio (HR)=0.83, P =0.028] and S-shaped curves (HR=0.43, P =0.014) were associated with ≥1 reoperation. Further analysis revealed age younger than 7 years (HR=0.48, P =0.021) was correlated with an increased risk of SGGS-related reoperation. The preoperative major curve was not significantly associated with any outcome measure. A reoperation-free survival rate of 50% corresponded to 3.5 years.</p><p><strong>Conclusion: </strong>SGGS instrumentation in patients younger than 7 years and patients with an S-shaped curve were associated with SGGS-related unplanned surgical interventions. Despite younger age being associated with likely complications, this procedure still benefits these children and provides significant curve correction while allowing growth.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"355-363"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143971214","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Atlantoaxial Instability in Collagen Type 2 Skeletal Dysplasias: Surgical Indications and Recommendations.","authors":"Bryan Menapace, William Mackenzie, Colleen Ditro, Kenneth Rogers, Jeffery Campbell, William G Stuart Mackenzie","doi":"10.1097/BPO.0000000000002955","DOIUrl":"10.1097/BPO.0000000000002955","url":null,"abstract":"<p><strong>Objective: </strong>Cervical spine atlantoaxial instability (AAI) is frequently encountered in skeletal dysplasias (SD), particularly in patients with collagen type 2 (COL2) mutations. The values of clinical examination, radiographic measurements, and magnetic resonance imaging (MRI) findings in determining when to intervene on COL2 AAI are unknown. The goal of this study is to compare these tools and report the utility and significance of each in surgical decision-making.</p><p><strong>Methods: </strong>A retrospective case-control series from a single center's skeletal dysplasia database, 2007 to 2023, included COL2 patients that had documented history, examination, and flexion-extension (F-E) cervical spine radiographs and MRI. Radiographic measurements included dens morphology, anterior atlanto-dens interval (AADI), and posterior atlanto-dens interval (PADI). MRI measurements included cervical stenosis, C1 space available for the cord (SAC), and presence of myelomalacia. Criteria cutoffs were defined by receiver operating characteristic analysis and a scoring rubric was generated by internal validation.</p><p><strong>Results: </strong>Of all SD patients, 78 of 547 (14%) had COL2 syndromes, and 53 (68%) met all inclusion criteria. The most common diagnosis was spondyloepiphyseal dysplasia (65%). Patients were majority 54% female and 80% white. Ten (19%) underwent surgery at an average age of 4.3 years. There were no differences in AAI clinical histories ( P = 0.18). Physical examination revealed higher rates of hyperreflexia in the surgical group ( P = 0.0002). On radiographs, surgical patients had more os odontoidea ( P = 0.0001) and greater change in AADI and PADI ( P = 0.01 and P < 0.0001). On MRI, surgical patients had myelomalacia more frequently ( P < 0.0001), more severe stenosis ( P = 0.02), and greater change in SAC ( P = 0.01). receiver operating characteristic analysis defined 7 surgical cutoffs as follows: (1) presence of hyperreflexia, (2) radiographic os odontoid, (3 and 4) F-E radiographs with ≥5 mm change in AADI and/or PADI, (5) myelomalacia on MRI, (6) C1-C2 stenosis ≥80%, and (7) ≥1.5 mm of C1-C2 SAC change on F-E MRI. Applying those cutoffs, it was determined that 100% of patients with 0 to 1 criteria were able to be managed nonoperative. Conversely patients with 4 or more criteria present were indicated for surgery in 80% of cases.</p><p><strong>Conclusion: </strong>This is the largest case series on AAI in SD patients with COL2-associated conditions. This study identified 7 criteria that could be used to indicate surgical intervention. Patients who had ≤1 of these factors did not undergo surgery, while those with ≥4 had a high propensity to be recommended for surgical stabilization.</p><p><strong>Level of evidence: </strong>Level III.</p>","PeriodicalId":16945,"journal":{"name":"Journal of Pediatric Orthopaedics","volume":" ","pages":"431-437"},"PeriodicalIF":1.4,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753190","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}