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Minneapolis, MN, United States

Dykes D.C.,Twin Cities Spine Center | White III A.A.,Harvard University
Clinical Orthopaedics and Related Research | Year: 2011

Background: In its 2002 publication Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, the Institute of Medicine reported American racial and ethnic minorities receive lower-quality health care than white Americans. Because caregiver bias may contribute to disparate health care, the Liaison Committee on Medical Education and the Accreditation Council for Graduate Medical Education have issued specific directives to address culturally competent care education. Questions/purposes: We discuss the general approaches to culturally competent care education, the tools used in evaluating such endeavors, and the impact of such endeavors on caregivers and/or the outcomes of therapeutic interventions from three perspectives: (1) Where are we now? (2) Where do we need to go? (3) How do we get there? Methods: We summarized information from (1) articles identified in a PubMed search of relevant terms and (2) the authors' experience in delivering, evaluating, and promoting culturally competent care education. Where are we now? Considerable variation exists in approaches to culturally competent care education; specific guidelines and valid evaluation methods are lacking; and while existing education programs may promote changes in providers' knowledge and attitudes, there is little empirical evidence that such efforts reduce indicators of disparate care. Where do we need to go? We must develop evidence-based educational strategies that produce changes in caregiver attitudes and behaviors and, ultimately, reduction in healthcare disparities. How do we get there? We must have ongoing dialog about, development in, and focused research on specific educational and evaluation methodologies, while simultaneously addressing the economic, political, practical, and social barriers to the delivery of culturally competent care education. © 2011 The Association of Bone and Joint Surgeons®.

Cho W.,University of Virginia | Cho S.K.,University of Virginia | Cho S.K.,University of Washington | Wu C.,University of Virginia | Wu C.,Twin Cities Spine Center
Journal of Bone and Joint Surgery - Series B | Year: 2010

There are three basic concepts that are important to the biomechanics of pedicle screw-based instrumentation. First, the outer diameter of the screw determines pullout strength, while the inner diameter determines fatigue strength. Secondly, when inserting a pedicle screw, the dorsal cortex of the spine should not be violated and the screws on each side should converge and be of good length. Thirdly, fixation can be augmented in cases of severe osteoporosis or revision. A trajectory parallel or caudal to the superior endplate can minimise breakage of the screw from repeated axial loading. Straight insertion of the pedicle screw in the mid-sagittal plane provides the strongest stability. Rotational stability can be improved by adding transverse connectors. The indications for their use include anterior column instability, and the correction of rotational deformity. ©2010 British Editorial Society of Bone and Joint Surgery.

Study Design.: Case report with 40-year follow-up after definitive surgery. Objective.: To show that extensive spine fusion in a young child can control the curve and does not necessarily lead to early death. Summary of Background Data.: Recent efforts to avoid early spine fusion by using either progressive lengthening of spinal or rib cage implants are based on the theory that early spine fusion is deleterious and results in early death due to pulmonary compromise. Unfortunately, there is little to no documentation to support this theory. Methods.: This is a single case report of a child who at the age of 3 months had a 32° congenital thoracic congenital scoliosis with a unilateral unsegmented bar, concave fused ribs, and convex hemivertebrae. By age 2 years, the curve had progressed to 64°, so a posterior fusion was done from T5 to T12. By age 8 years, the curve had dramatically increased, and she was referred to the author. She underwent a double-wedge osteotomy, both anteriorly and posteriorly, plus anterior fusion T4-L3 and posterior fusion from T1 to L3. A halo cast was used for correction. Results.: At a 40-year follow-up after her definitive surgery at the age of 8 years, she is still alive and functioning well, although her vital capacity is poor. Conclusion.: Extensive thoracic spine fusion at an early age did not result in early death, but the patient is far from ideal. © 2012 Lippincott Williams & Wilkins.

Study Design: Case report with very long-term follow-up. Objective: To demonstrate the lasting value of correction and stabilization with multiple anterior autogenous strut grafting. Summary of Background Data: Although anterior strut grafting has been shown to be ideal for neurofibromatosis kyphosis, there have been no reports as to whether the benefit is maintained or lost over many years. Methods: This is a single case report with very long-term follow-up. Results: This adult patient, operated in February 1982, has been followed for 28 years, and is doing very well in life, although her pulmonary capacity is compromised. Conclusion: Although patients with severe spine deformity because of neurofibromatosis tend to deteriorate with time, this patient demonstrates that with aggressive correction and fusion management, a long-term good quality of life can be achieved. © 2011 Lippincott Williams & Wilkins.

Winter R.B.,Twin Cities Spine Center | Burger E.L.,University of Colorado at Denver
Spine | Year: 2012

STUDY DESIGN.: Case report. OBJECTIVE.: To demonstrate a 36-year follow-up of a rare operation. SUMMARY OF BACKGROUND DATA.: There have been no reports of follow-up of pediatric hemivertebra excision and fusion into midadult life. METHODS.: A chart and radiological review at 36 years after surgery. RESULTS.: The patient is alive and well and leading a normal life. Her Oswestry Disability Index is 0. Mild degenerative radiological signs are evident at the adjacent level above (T10-T12) and below (sacroiliac joints). CONCLUSION.: Early excision of the L5 hemivertebra would have been preferable, but the long-term results are good. © 2012, Lippincott Williams & Wilkins.

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