What's New in Pediatric Orthopaedics???- Review by Kim and Noonan

In the latest issue of the journal JB and JS,  authours Young-Jo Kim, MD, PhD¹ 

and Kenneth J. Noonan, MD published their reviews on"Pediatric Orthopaedics". 

They discuss about the recent advancements in the field of Pediatric Orthopadics 

with emphasis on various spine deformity, neurological disorders in childrens with 

appropirate surgical methods used. They have done an excellent review of the literature, 

the 82 references listed can be useful for those in the Pediatric Ortho as well as for 

Neurophysiologists. There is a section on basic science applications and in another 

section on spine, they talk about effectiveness of Intraoperative monitoring 

using motor evoked potentials.

The effectiveness of spinal cord monitoring during spinal deformity surgery was recently reported in two large studies (involving >1000 patients), with the incidence of spinal cord injury approaching 1%^66,67. Transcranial motor-evoked potentials are exquisitely sensitive to threatened spinal cord function, andtheir use together with traditional somatosensory evoked potentials improves the accuracy of spinal cord monitoring. Somatosensory evoked potentials may not detect all problems and may not detect problems as rapidly as transcranial motor-evoked potentials do⁶⁷, and the sensitivity of transcranial motor-evoked potentials has led some centers to abandon somatosensory evoked potentials in favor of motor monitoring alone. For instance, Hsu et al.⁶⁸ reported 100% sensitivity for the detection of a clinically important neurological event in a consecutive series of 144 patients. The authors defined a neurological event as either a new postoperative deficit or a 50% decrease in the monitoring potential over a one-minute period. The rapidity with which motor monitoring detects spinal cord compromise makes it a valuable tool for sagittal plane correction, and prompt detection of a problem can lead to its resolution before a permanent deficit results^69,70.

The Journal of Bone and Joint Surgery (American). 2009;91:743-751.doi:10.2106/JBJS.H.01689

How Much Risk Surgery Posses & What Neuromonitoring can Do?

Michael Dinkel et al., writes about the possible risks and outcomes of patients with disability in various surgery, and how neuromonitoring can help prevent such risks by identifying and localizing the risks in time?.

Intraoperative Neurophysiologic Monitoring
Michael Dinkel, M.D.
Department of Anaesthesiology Frankenwaldklinik
Ulrich Beese, M.D.
Department of Anaesthesiology University of Erlangen-Nuremberg
Michael Messner, M.D.
Department of Anaesthesiology University of Erlangen-Nuremberg
Citation:

Michael Dinkel, Ulrich Beese, Michael Messner: Intraoperative Neurophysiologic Monitoring .
The Internet Journal of Neuromonitoring. 2001 . Volume 2 Number 2.


The rate of permanent recurrent laryngeal nerve paresis after thyroidectomy for instance comes up to 9%. Almost 40% of patients with acute dissection of the thoracoabdominal aorta suffer from paraplegia after aneurysm repair. Despite a wake-up test 0.7 to 1.6% are paraplegic after corrective procedures for scoliosis. After cardiac procedures with extracorporal circulation there is a 1 to 3% incidence of severe neurologic deficits and an incidence of cognitive deficits running up to 80%. Finally the stroke rate after carotid endarterectomy comes to 7% in well documented series [2, 3 , 4 ,5,7].
Further Reading: click the above topic linked.....!

Scoliosis & More

The following article on Scoliosis provide a comprehensive look at what is scoliosis and related surgical interventions. Though, hard to explain the causes for scolisosis, efforts to understand this disease provided us more knowledge. Intraoperative neuromonitoring is extensively used in scoliosis correction surgical procedures.

Scoliosis and Proprioception
Robert Schleip
Published in Rolf Lines, Vol. 28, No.4 (Fall 2000)
Most types of scoliosis are classified as ‘idiopathic scoliosis’ which means that the reasons for this type of rotational deformity of the spine are yet unknown. Nevertheless there are all kinds of assumptions, beliefs and anectdotal reports available in the alternative health community concerning the main causes and driving factors.........................


Central Nervous System Processing in Idiopathic Scoliosis
By Jerry Larson, M.A.
Diplomate, American Board of Neurophysiological Monitoring

"The clinical manifestations of idiopathic scoliosis are well known, yet its causes remain unclear. Several factors have been proposed, including abnormal structural elements of the spine, dysfunctional spinal musculature, genetic factors, alterations of collagen metabolism, and abnormalities of the central nervous system. The most promising investigations appear to implicate the central nervous system, especially those areas involved with postural equilibrium. Spinal cord reflexes play an integral role in the maintenance of posture. These complex polysynaptic segmental reflexes are regulated by a variety of descending suprasegmental systems, by peripheral afferent impulses and within the spinal ....................