Texas Scottish Rite Hospital Research Articles

23rd Annual Carrell-Krusen Symposium, Texas Scottish Rite Hospital for Children, Dallas, Texas, February 22–23, 2001 Meeting Convenor: Susan T. Iannaccone, MD, FAAN

23rd Annual Carrell-Krusen Symposium, Texas Scottish Rite Hospital for Children, Dallas, Texas, February 22–23, 2001 Meeting Convenor: Susan T. Iannaccone, MD, FAAN

23rd Annual Carrell-Krusen Symposium, Texas Scottish Rite Hospital for Children, Dallas, Texas, February 22–23, 2001 Meeting Convenor: Susan T. Iannaccone, MD, FAAN

23rd Annual Carrell-Krusen Symposium, Texas Scottish Rite Hospital for Children, Dallas, Texas, February 22–23, 2001 Meeting Convenor: Susan T. Iannaccone, MD, FAAN

23rd Annual Carrell-Krusen Symposium, Texas Scottish Rite Hospital for Children, Dallas, Texas, February 22–23, 2001 Meeting Convenor: Susan T. Iannaccone, MD, FAAN

23rd Annual Carrell-Krusen Symposium, Texas Scottish Rite Hospital for Children, Dallas, Texas, February 22–23, 2001 Meeting Convenor: Susan T. Iannaccone, MD, FAAN

23rd Annual Carrell-Krusen Symposium, Texas Scottish Rite Hospital for Children, Dallas, Texas, February 22–23, 2001 Meeting Convenor: Susan T. Iannaccone, MD, FAAN

23rd Annual Carrell-Krusen Symposium, Texas Scottish Rite Hospital for Children, Dallas, Texas, February 22–23, 2001 Meeting Convenor: Susan T. Iannaccone, MD, FAAN

23rd Annual Carrell-Krusen Symposium, Texas Scottish Rite Hospital for Children, Dallas, Texas, February 22–23, 2001 Meeting Convenor: Susan T. Iannaccone, MD, FAAN

23rd Annual Carrell-Krusen Symposium, Texas Scottish Rite Hospital for Children, Dallas, Texas, February 22–23, 2001 Meeting Convenor: Susan T. Iannaccone, MD, FAAN

23rd Annual Carrell-Krusen Symposium, Texas Scottish Rite Hospital for Children, Dallas, Texas, February 22–23, 2001 Meeting Convenor: Susan T. Iannaccone, MD, FAAN

23rd Annual Carrell-Krusen Symposium, Texas Scottish Rite Hospital for Children, Dallas, Texas, February 22–23, 2001 Meeting Convenor: Susan T. Iannaccone, MD, FAAN

23rd Annual Carrell-Krusen Symposium, Texas Scottish Rite Hospital for Children, Dallas, Texas, February 22–23, 2001 Meeting Convenor: Susan T. Iannaccone, MD, FAAN

23rd Annual Carrell-Krusen Symposium, Texas Scottish Rite Hospital for Children, Dallas, Texas, February 22–23, 2001 Meeting Convenor: Susan T. Iannaccone, MD, FAAN

23rd Annual Carrell-Krusen Symposium, Texas Scottish Rite Hospital for Children, Dallas, Texas, February 22–23, 2001 Meeting Convenor: Susan T. Iannaccone, MD, FAAN

23rd Annual Carrell-Krusen Symposium, Texas Scottish Rite Hospital for Children, Dallas, Texas, February 22–23, 2001 Meeting Convenor: Susan T. Iannaccone, MD, FAAN

23rd Annual Carrell-Krusen Symposium, Texas Scottish Rite Hospital for Children, Dallas, Texas, February 22–23, 2001 Meeting Convenor: Susan T. Iannaccone, MD, FAAN

23rd Annual Carrell-Krusen Symposium, Texas Scottish Rite Hospital for Children, Dallas, Texas, February 22–23, 2001 Meeting Convenor: Susan T. Iannaccone, MD, FAAN

23rd Annual Carrell-Krusen Symposium, Texas Scottish Rite Hospital for Children, Dallas, Texas, February 22–23, 2001 Meeting Convenor: Susan T. Iannaccone, MD, FAAN

23rd Annual Carrell-Krusen Symposium, Texas Scottish Rite Hospital for Children, Dallas, Texas, February 22–23, 2001 Meeting Convenor: Susan T. Iannaccone, MD, FAAN

23rd Annual Carrell-Krusen Symposium, Texas Scottish Rite Hospital for Children, Dallas, Texas, February 22–23, 2001 Meeting Convenor: Susan T. Iannaccone, MD, FAAN

23rd Annual Carrell-Krusen Symposium, Texas Scottish Rite Hospital for Children, Dallas, Texas, February 22–23, 2001 Meeting Convenor: Susan T. Iannaccone, MD, FAAN

23rd Annual Carrell-Krusen Symposium, Texas Scottish Rite Hospital for Children, Dallas, Texas, February 22–23, 2001 Meeting Convenor: Susan T. Iannaccone, MD, FAAN

23rd Annual Carrell-Krusen Symposium, Texas Scottish Rite Hospital for Children, Dallas, Texas, February 22–23, 2001 Meeting Convenor: Susan T. Iannaccone, MD, FAAN

23rd Annual Carrell-Krusen Symposium, Texas Scottish Rite Hospital for Children, Dallas, Texas, February 22–23, 2001 Meeting Convenor: Susan T. Iannaccone, MD, FAAN

23rd Annual Carrell-Krusen Symposium, Texas Scottish Rite Hospital for Children, Dallas, Texas, February 22–23, 2001 Meeting Convenor: Susan T. Iannaccone, MD, FAAN

23rd Annual Carrell-Krusen Symposium, Texas Scottish Rite Hospital for Children, Dallas, Texas, February 22–23, 2001 Meeting Convenor: Susan T. Iannaccone, MD, FAAN

23rd Annual Carrell-Krusen Symposium, Texas Scottish Rite Hospital for Children, Dallas, Texas, February 22–23, 2001 Meeting Convenor: Susan T. Iannaccone, MD, FAAN

23rd Annual Carrell-Krusen Symposium, Texas Scottish Rite Hospital for Children, Dallas, Texas, February 22–23, 2001 Meeting Convenor: Susan T. Iannaccone, MD, FAAN

23rd Annual Carrell-Krusen Symposium, Texas Scottish Rite Hospital for Children, Dallas, Texas, February 22–23, 2001 Meeting Convenor: Susan T. Iannaccone, MD, FAAN

SOUTHERN PEDIATRIC NEUROLOGY SOCIETY, 25th Annual Meeting, Texas Scottish Rite Hospital for Children, Dallas, Texas, February 26, 2000

SOUTHERN PEDIATRIC NEUROLOGY SOCIETY, 25th Annual Meeting, Texas Scottish Rite Hospital for Children, Dallas, Texas, February 26, 2000

Texas Scottish Rite Hospital instrumentation for correction of idiopathic scoliosis: short-term results

In this prospective study 27 consecutive patients of an average age of 20±8 years suffering from idiopathic scoliosis were operated on using the Texas Scottish Rite Hospital (TSRH) instrumentation in the period from 1992 to 1995 and were evaluated at a minimum follow-up of 26 months postoperatively. Curvature correction, derotation of the apical vertebra, frontal and sagittal trunk balance, and L3–L4 and L4–L5 disc-space wedging were evaluated prepostoperatively and at the maximum follow-up of 54 months. The average correction of the thoracic and lumbar scolioses that was obtained immediately postoperatively averaged 41% and 51% respectively. An average 2–4° and 4–5° loss of correction was dependent on King type in the thoracic and lumbar scoliotic curves respectively was observed at the longest follow-up. Thoracic kyphosis and lumbar lordosis did not significantly change. No significant derotation of thoracic and lumbar apical vertebral rotation was achieved by TSRH but the preoperatively laterally shifted apical vertebra was translated by TSRH instrumentation towards the midline (p<0.001). The position of the T1, and C7 vertebrae in the sagital frontal plane was not significantly changed by TSRH instrumentation postoperatively. The preoperative wedging of the intervertebral spaces L3–L4 and L4–L5 was simultaneously significantly (p<0.01) reduced by TSRH with subsequent horizontalization of the L3, L4 and L5 vertebrae. No trunk decompensation, neurologic complications, infection or pseudarthroses occurred. Lumbar hook dislodgment occurred in the early post-operative period in two patients because of insufficient TSRH rod contouring at the beginning of our learning curve. TSRH is a safe instrumentation that corects idiopathic scoliosis satisfactorily, maintains frontal and sagittal vertebral balance by translating the apical vertebra towards the midline and simultaneously correcting the lowermost lumbar vertebral tilting without associated infection, neurologic complications or decompensation.

22nd Annual Carrell-Krusen Symposium. Dallas, Texas, USA. February 24-25, 2000. Abstracts.

22nd Annual Carrell-Krusen Symposium. Dallas, Texas, USA. February 24-25, 2000. Abstracts.

Mechanical Evaluation of Cross-Link Designs in Rigid Pedicle Screw Systems

Study Design. This study was designed to evaluate the biomechanical performance of 5 different cross-link brands to determine which design characteristics are biomechanically desirable. Methods. The Cotrel-Dubousset, Isola, Puno Winter Byrd, Rogozinski, and Texas Scottish Rite Hospital sys tems were assembled to vertebral models according to the manufacturer's specifications. Three constructs were tested for each brand of instrumentation: without cross links, with one cross-link, and with two cross-links. Four modes of loading: axial, torsional, flexion-extension, and lateral-flexion were used. Load-displacement curves were plotted. The stiffness was calculated from the slope of these curves. Objectives. Five different rigid pedicle screw systems were tested to determine: 1) what are the characteristics of cross-link design that are most effective in limiting torsional motion; 2) whether two cross-links are more effective than one; and 3) whether cross-linkage in creases the construct stiffness in lateral bending. Summary of Background Data. Cross-linkage has been shown to increase the torsional stiffness of rod and screw constructs. Increased construct stiffness has been correlated with higher fusion rates. Results. Increases in axial, flexion-extension, or lat eral-flexion stiffness, with the addition of one or two cross-links, were not statistically significant. In torsional loading, increases in stiffness within brands were statis tically significant in every case. The average increase was 44% with one added cross-link and 26% with two. The magnitude of the increase in torsional stiffness was compared with the cross-sectional area of the respec tive cross-link. Greater stiffness correlated with larger cross-sectional area (r = 0.81 for one cross-link, and r = 0.60 for two). Conclusion. The use of cross-linkage in spinal fusion increases torsional stiffness in pedicle screw and hook constructs. This study 1) confirmed the effectiveness of cross-linkage in limiting torsional motion and showed the superiority of two cross-links to one cross-link in limiting torsional motion, 2) showed that increase of torsional stiffness of a cross-linked construct is propor tional to the cross-sectional area of the cross-link, and 3) demonstrated that cross-links do not increases stiffness in the lateral flexion mode.

Treatment of Adolescent Idiopathic Scoliosis Using Texas Scottish Rite Hospital Instrumentation

Study Design. To determine the effectiveness of posterior TSRH instrumentation for the treatment of idiopathic scoliosis, 103 patients with a 2-year minimum followup were retrospectively studied. Methods. Patients who underwent operations between October 1988 and April 1991 were evaluated for curve correction, spinal balance, and complications. Age at surgery averaged 14.3 years. Follow-up averaged 2.5 years. Results. Thoracic curve correction averaged 65% in those with King Type III/IV curves and 54% in those with Type II curves. With follow-up, correction loss averaged approximately 13% for each group. Lumbar curve correction after instrumentation in Type I and II curves averaged 48% postop but lost approximately 20% with follow-up. Trunk balance improved 77% toward midline after surgery in those with Type III/IV curves. Improvement in trunk balance was less impressive in patients with Type II curves, particularly after selective thoracic fusions. Thoracic sagittal contour improved 43% for hypokyphotic (<20°) patients but, in the remainder, no significant radiographic change was evident. No neurologic complications occurred. Delayed deep infections developed in ten patients (10%) between 11 and 45 months postoperative. Cultures eventually grew Propionibacterium acnes, staph epidermidis, or staph coagulase negative in eight patients. Two patients had pseudarthroses. Conclusions. Frontal and sagittal thoracic curve correction can be satisfactorily obtained using TSRH instrumentation. Continued efforts are being made to improve lumbar hook patterns and technique to achieve and maintain better lumbar curve correction.