Childrens Mercy Hospital Kansas

Kansas City, MO, United States

Childrens Mercy Hospital Kansas

Kansas City, MO, United States
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Koreckij J.,Hospital Hill | Price N.,Childrens Mercy Hospital | Schwend R.M.,Childrens Mercy Hospital Kansas
Spine | Year: 2011

STUDY DESIGN.: Prospective, two-way complete block design analyzing facial contact pressures during prone positioning with the use of cervical traction for spinal surgery. Level 2 evidence. OBJECTIVE.: To assess the effect of varying traction angle and traction weight to limit facial contact pressure. SUMMARY OF BACKGROUND DATA.: Posterior spine surgery has known hazards related to the prone positioning. Cervical traction is used to limit downward pressure exerted to the face to stabilize the head and neck and to aide in deformity correction. The effects of the traction angle and force on facial contact pressure have not been studied. METHODS.: Facial contact pressure was measured for 10 patients undergoing posterior spine surgery in the prone position with Gardner-Wells tongs applied for cervical traction. The facial contact pressure was measured with a force transducer at each of three angles from horizontal (0°, 30°, 45°) and each of four traction weights (0, 5, 10,15 lb), a total of 12 measurement parameters for each patient. An in-line tensiometer provided consistent application of force throughout the traction system. RESULTS.: Ten patients, average age 15 ± 0.6 years, six female, BMI 21.3 ± 1.7, underwent facial pressure monitoring. Post hoc analysis showed that both higher traction weights and angles significantly limited facial pressure (P = 0.0001). The lowest overall average facial pressure of 0.51 lb (95% CI = 0.28-0.73) occurred with 15 lb of traction applied at 45° above the horizontal. This was significantly less facial pressure than found when traction was applied at all weights tested using the commonly employed 0° in-line traction angle (P < 0.0001). CONCLUSION.: A combination of upward vectored 45° traction angle and 15 lb of weight significantly decreased facial contact pressure. The use of an "in-line tensiometer" assured an accurate force application. Copyright © 2011 Lippincott Williams & Wilkins.


Hotchkiss W.R.,University of Texas Southwestern Medical Center | Schwend R.M.,Childrens Mercy Hospital Kansas | Bosch P.P.,University of Pittsburgh | Edgar H.J.H.,University of New Mexico | Young B.N.,University of New Mexico
Spine Deformity | Year: 2016

Study Design Comparing thoracic pedicle screw trajectories, screw lengths, and starting points by examining osteologic specimens. Objective Describe a medial screw trajectory (MST) compared to a screw trajectory along the anatomic pedicle angle (APA) in terms of trajectory, screw length, and starting point. Summary of Background Data Although thoracic pedicle screw insertion is commonly used for posterior fusion and instrumentation, there is little data to quantify an MST that avoids the great vessels and allows for greater screw purchase. Methods Thirty adult female skeleton thoracic vertebral columns from the University of New Mexico Maxwell Museum of Anthropology Osteology Collection were photographed from axial and right and left lateral views from T1 to T12. Axial plane measurements included APA and MST (both measured from the midline), screw lengths, and APA/MST intersection on the superior articular facet (SAF). The MST was defined as an insertion angle through the midpoint of the pedicle isthmus intersecting the anterior midpoint of the vertebral body. The intersection of each trajectory with the SAF was measured in relation to the lateral base of the SAF, reported as a percentage of the SAF base width from the lateral SAF border. Results At every vertebral level, the APA was different from the MST for angle, screw length, and SAF intersection (p <.0001), with the largest difference at T12. The T12 differences were APA versus MST angles (-25.5°, 95% CI -22.7° to -28.4°), screw lengths (11.0 mm, 95% CI 9.2 mm to 12.9 mm), and percentage of SAF width from the lateral border of the SAF base (38.6%, 95% CI 29.1% to 48.1%). Conclusions The MST was approximately 8° to 10° greater at T1-T10 (19° at T11 and 25° at T12) than the traditional APA insertion angle. This resulted in a much more lateral starting point on the SAF and longer screw length, greatest at T12. © 2016 Scoliosis Research Society.


St Peter S.D.,Childrens Mercy Hospital Kansas | Acher C.W.,University of Wisconsin - Madison | Shah S.R.,Childrens Mercy Hospital Kansas | Sharp S.W.,Childrens Mercy Hospital Kansas | Ostlie D.J.,University of Wisconsin - Madison
Journal of Laparoendoscopic and Advanced Surgical Techniques | Year: 2016

Introduction: Despite evidence from prospective trials and meta-analyses supporting laparoscopic pyloromyotomy (LP) over open pyloromyotomy (OP), the open technique is still utilized by some surgeons on the premise that there is minimal clinical benefit to LP over OP. Although the potential cosmetic benefit of LP over OP is often cited in reports, it has never been objectively evaluated. Methods: After internal review board approval, the parents of patients from a previous prospective trial who had undergone LP (n = 9) and OP (n = 10) were contacted. After consent was obtained, the parents and patients were asked to complete a validated scar scoring questionnaire that was compared between groups. Standardized photos were taken of study subjects and controls with no abdominal procedures. Blinded volunteers were recruited to view the photos, identify if scars were present, and complete questions if a scar(s) was seen. Volunteers were also asked about the degree of satisfaction if their child had similar scars on a four-point scale from happy to unacceptable. Results: Mean age was 7 years in both groups. Parental scar assessment scores were superior in the LP group in every category. Blinded volunteers detected abdominal scars significantly more often in the OP group (98%) vs. the LP group (28%; P < .001). The volunteers detected a scar in 16% of the controls, comparable to the 28% detected in the LP group (P = .17). The degree of satisfaction estimate by volunteers was 1.78 for OP and 1.02 for LP and controls, generating a Cohen's d effect size of 5.1 standard deviation units comparing OP to either LP or controls (very large ≥1.3). Conclusions: Parents of children scored LP scars superior to OP scars. Surgical scars are almost always identifiable with OP while the surgical scars associated with LP approach invisibility to the observer, appearing similar to patients with no prior abdominal operation. © Copyright 2016, Mary Ann Liebert, Inc. 2016.


PubMed | University of Wisconsin - Madison and Childrens Mercy Hospital Kansas
Type: Comparative Study | Journal: Journal of laparoendoscopic & advanced surgical techniques. Part A | Year: 2016

Despite evidence from prospective trials and meta-analyses supporting laparoscopic pyloromyotomy (LP) over open pyloromyotomy (OP), the open technique is still utilized by some surgeons on the premise that there is minimal clinical benefit to LP over OP. Although the potential cosmetic benefit of LP over OP is often cited in reports, it has never been objectively evaluated.After internal review board approval, the parents of patients from a previous prospective trial who had undergone LP (n=9) and OP (n=10) were contacted. After consent was obtained, the parents and patients were asked to complete a validated scar scoring questionnaire that was compared between groups. Standardized photos were taken of study subjects and controls with no abdominal procedures. Blinded volunteers were recruited to view the photos, identify if scars were present, and complete questions if a scar(s) was seen. Volunteers were also asked about the degree of satisfaction if their child had similar scars on a four-point scale from happy to unacceptable.Mean age was 7 years in both groups. Parental scar assessment scores were superior in the LP group in every category. Blinded volunteers detected abdominal scars significantly more often in the OP group (98%) vs. the LP group (28%; P<.001). The volunteers detected a scar in 16% of the controls, comparable to the 28% detected in the LP group (P=.17). The degree of satisfaction estimate by volunteers was 1.78 for OP and 1.02 for LP and controls, generating a Cohens d effect size of 5.1 standard deviation units comparing OP to either LP or controls (very large 1.3).Parents of children scored LP scars superior to OP scars. Surgical scars are almost always identifiable with OP while the surgical scars associated with LP approach invisibility to the observer, appearing similar to patients with no prior abdominal operation.

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