Texas Scottish Rite Hospital Research Articles

Factor Analysis of the Effectiveness of Transfixation and Rod Characteristics on the TSRH Screw-Rod Instrumentation

The effects of Texas Scottish Rite Hospital (TSRH) hardware parameters (rod length and diameter and cross-link) and their interaction on the stiffness of the TSRH pedicle screw-rod construct were evaluated. Four TSRH screws were assembled in pairs to two polymethyl-methacrylate blocks to resemble a one-level or more corpectomy model and the construct underwent nondestructive torsional, extension, and flexion loading. In every loading test, each construct was tested using TSRH rods of different lengths (10, 15, and 20 cm) and diameters (4.9 and 6.5 mm) and different cross-links (TSRH and two new types made for this experiment). We compared the stiffness of the construct without cross-linking with that with single or double TSRH cross-linking, or either the closed new-type cross-link (closed NTC) or the open new-type cross-link (open NTC) using factor analysis. There was no axial slipping of one rod versus the other up to a force of 100 kg. The stiffness of the construct in all three loading modes increased as the rod length decreased, the rod diameter increased, and the construct was augmented with a cross-link. The closed NTC provided the greatest stiffness and the single TSRH provided the least stiffness. Unaugmented 10-cm-long rods showed two or three times more torsional stiffness than did that of the longer unaugmented rods independent of rod diameter. In addition, the closed NTC offered the maximal increase in flexion stiffness of the construct with thick rods and 10-, 15-, and 20-cm-long rods at a maximum of 40%, 27%, and 30%, respectively. This rigid closed NTC increased the extension stiffness of the same construct with 10- and 15-cm-long rods at 40% and 6%, respectively, whereas it had no influence on the extension stiffness of 20-cm-long rods.

The use of botulinum toxin type A in children with cerebral palsy: a retrospective study

The dosage and safety of botulinum toxin type A (BTX‐A) treatments in 104 children with cerebral palsy were examined in a retrospective chart review of a 2‐year period at Texas Scottish Rite Hospital for Children. Almost all of the BTX‐A injections were to the muscles of the lower limbs. The average dose of BTX‐A was 8–9 Ukg body weight and the interval between injections averaged 3–5 months. The average total amount of BTX‐A injected at a single visit ranged from 146 to 186 U. The safety record for these treatments was excellent, with only 14 adverse events reported in 257 patient injection visits. The most commonly reported adverse event was muscle weakness, which is related to the pharmacology of BTX‐A treatment

Trigger finger in children.

At the Texas Scottish Rite Hospital for Children, 239 trigger digits in 176 children were seen and treated surgically over a 10-year period. Trigger fingers accounted for 33 (14%) of these digits in 18 (10%) of the patients. In 8 of 18 patients (44%) the fingers continued to trigger after A-1 pulley release. In children, trigger fingers are different from trigger thumbs. Trigger fingers in children are uncommon and have variable causes, and an A-1 pulley release alone will not always correct the triggering. Additional treatments, such as resection of one or both limbs of the sublimis tendon or an A-3 pulley release, may be required. An awareness of other contributing factors and readiness to explore the entire flexor mechanism should help prevent failure of surgical treatment.

Torsional Stiffness of a Single-Rod Construct Using Three Instrumentation Systems for Thoracic Scoliosis

Three instrumentation systems were tested using a unilateral rod construct for instrumenting thoracic scoliosis. Thoracic calf spines were instrumented with Texas Scottish Rite Hospital (TSRH), Cotrel Dubousset (CD), and Isola single-rod instrumentation systems. The constructs were mechanically tested, and rotational displacement and torsional stiffness were determined. The TSRH instrumentation was found to have significantly less rotational displacement and to be significantly stiffer in torsion than the uninstrumented control. The CD and Isola systems were not significantly different than the uninstrumented calf spine.

Torsional Stiffness of a Single-Rod Construct Using Three Instrumentation Systems for Thoracic Scoliosis

Summary: Three instrumentation systems were tested using a unilateral rod construct for instrumenting thoracic scoliosis. Thoracic calf spines were instrumented with Texas Scottish Rite Hospital (TSRH), Cotrel Dubousset (CD), and Isola single-rod instrumentation systems. The constructs were mechanically tested, and rotational displacement and torsional stiffness were determined. The TSRH instrumentation was found to have significantly less rotational displacement and to be significantly stiffer in torsion than the uninstrumented control. The CD and Isola systems were not significantly different than the uninstrumented calf spine.

Epidural Analgesia for Pain Relief After Scoliosis Surgery in a Patient with Rett's Syndrome

Epidural Analgesia for Pain Relief After Scoliosis Surgery in a Patient with Rett's Syndrome

Anterior only fusion for scoliosis in patients with myelomeningocele.

A series of patients with single major scoliosis curvatures attributable to spina bifida treated by anterior only spinal fusion was studied for 2 years to determine whether the infection rate could be decreased, adequate correction and pelvic balance could be provided, and posterior surgery could be avoided in these patients. Anterior surgery alone was performed for thoracolumbar scoliosis greater than 45 degrees if the compensatory thoracic curve was less than 40 degrees and there was no significant junctional kyphosis. Fourteen patients were treated at a mean age of 11.9 years (range, 7-16 years), with a mean curve of 64 degrees (range, 51 degrees-85 degrees), and motor levels distributed from T10-L4. Thirteen patients had prior neurosurgery for tether, syrinx, or Arnold-Chiari malformation. The spine was fused over a mean of seven vertebrae. A 3/16 inch Texas Scottish Rite Hospital rod was used most commonly (10 patients). Blood loss averaged 1100 cc. The mean curve correction was 57% at 40 months after surgery. Loss of correction occurred primarily by adding on outside the instrumented area. Mean pelvic obliquity was improved from 16 degrees to 9 degrees. There was one superficial infection. Results were good in five patients, fair in four, and poor in five. Failures were attributable to proximal decompensation in two patients who required revision surgery (two), neurologic deterioration in two, and screw pullout in one. Both patients with decompensation had syringomyelia. Both patients with neurologic deterioration had large curves (> 75 degrees). Both patients recovered after rod removal. Retrospectively, by eliminating patients with syrinx or with a curve greater than 75 degrees, all poor results would be eliminated. Anterior only fusion and instrumentation may have significant advantages, but only for selected patients with thoracolumbar curves less than 75 degrees, compensatory curves less than 40 degrees, no increased kyphosis, and no syrinx. Quadriceps function should be monitored. On the basis of this preliminary experience, continued use of this approach using stricter selection seems warranted.

Does spinal instrumentation influence the healing process of posterolateral spinal fusion? An in vivo animal model.

An in vivo sheep model was used to investigate the effect of spinal instrumentation on the healing process of posterolateral spinal fusion. To examine the role of spinal instrumentation during the healing process of posterolateral fusion. In long bone fractures, internal fixation improves the union rate but does not accelerate the healing process. Spinal instrumentation also improves the fusion rate in spinal arthrodesis. However, it remains unclear whether the use of spinal instrumentation expedites the healing process of spinal fusion. Sixteen sheep underwent posterolateral spinal arthrodeses at L2-L3 and L4-L5 using equal amounts of autologous bone. One of those segments was selected randomly to be augmented with transpedicular screw fixation (Texas Scottish Rite Hospital spinal system). The animals were killed at 8 weeks or 16 weeks after surgery. Fusion status was evaluated by biomechanical testing, manual palpation, plain radiography, computed tomography, and histology. Instrumented fusion segments demonstrated significantly higher stiffness than did uninstrumented fusions at 8 weeks after surgery. Radiographic assessment and manual palpation showed that the use of spinal instrumentation improved the fusion rate at 8 weeks (47% versus 38% in radiographs, 86% versus 57% in manual palpation). Histologically, the instrumented fusions consisted of more woven bone than the uninstrumented fusions at 8 weeks after surgery. The 16-week-old fusion mass was diagnosed biomechanically, radiographically, and histologically as solid, regardless of pedicle screw augmentation. The current study's results demonstrated that spinal instrumentation creates a stable mechanical environment to enhance the early bone healing of spinal fusion.

Oral phenylalanine loading profiles in symptomatic and asymptomatic gene carriers with dopa-responsive dystonia due to dominantly inherited GTP cyclohydrolase deficiency.

Journal of Inherited Metabolic DiseaseVolume 22, Issue 3 p. 213-215 Article Oral phenylalanine loading profiles in symptomatic and asymptomatic gene carriers with dopa-responsive dystonia due to dominantly inherited GTP cyclohydrolase deficiency K. Hyland, Corresponding Author K. Hyland k.hyland@baylordallas.edu Institute of Metabolic Disease, Dallas, Texas, USA Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USAk.hyland@baylordallas.eduSearch for more papers by this authorT. G. Nygaard, T. G. Nygaard Department of Neurology, Columbia Presbyterian Medical Center, New York, USASearch for more papers by this authorJ. M. Trugman, J. M. Trugman Department of Neurology, University Virginia Health Sciences Center, Charlottesville, Virginia, USASearch for more papers by this authorK. J. Swoboda, K. J. Swoboda Division of Genetics, Children's Hospital and Harvard Medical School Boston, Massachusetts, USASearch for more papers by this authorL. A. Arnold, L. A. Arnold Institute of Metabolic Disease, Dallas, Texas, USASearch for more papers by this authorS. P. Sparagana, S. P. Sparagana Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA Texas Scottish Rite Hospital for Children, Dallas, Texas, USASearch for more papers by this author K. Hyland, Corresponding Author K. Hyland k.hyland@baylordallas.edu Institute of Metabolic Disease, Dallas, Texas, USA Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USAk.hyland@baylordallas.eduSearch for more papers by this authorT. G. Nygaard, T. G. Nygaard Department of Neurology, Columbia Presbyterian Medical Center, New York, USASearch for more papers by this authorJ. M. Trugman, J. M. Trugman Department of Neurology, University Virginia Health Sciences Center, Charlottesville, Virginia, USASearch for more papers by this authorK. J. Swoboda, K. J. Swoboda Division of Genetics, Children's Hospital and Harvard Medical School Boston, Massachusetts, USASearch for more papers by this authorL. A. Arnold, L. A. Arnold Institute of Metabolic Disease, Dallas, Texas, USASearch for more papers by this authorS. P. Sparagana, S. P. Sparagana Department of Neurology, University of Texas Southwestern Medical Center, Dallas, Texas, USA Texas Scottish Rite Hospital for Children, Dallas, Texas, USASearch for more papers by this author First published: 01 May 1999 https://doi.org/10.1023/A:1005532610051Citations: 17AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume22, Issue3May 1999Pages 213-215 RelatedInformation

胸椎および腰椎への instrumentation surgery

<Objective> The authors conducted a study to evaluate the clinical outcome of 21 patients in whom thoracolumbar spinal instrumentation surgery was used. <Methods> The study group was composed of 11 men and 10 women with the mean age being 43 years (range 19-73 years). The diagnosis was spinal trauma in 14 patients; metastatic spinal tumor in 4; and infectious disease in 3. The affected level was midthoracic in 8 patients, thoracolumbar in 12, and lumbar in one. Anterior spinal fixation was carried out in 13 patients using Kaneda device in six, and Z-plate in seven. Posterior spinal fixation was performed in eight patients using Texas Scottish Rite Hospital (TSRH) system. Solid bony fusion was achieved in all patients who received autologous bone transplantation. Good neurological outcome was obtained in 18 of 21 patients independently of whether the fixation was by anterior or posterior instrumentation. The 3 patients who had sustained complete spinal cord injury didn't recover neurologically. Radiographical recovery of kyphosis using Kaneda device, Z-plate and TSRH were obtained to the extent of 9 degrees, 3 degrees and 1 degree, respectively. One patient with posterior instrumentation developed deep wound infection. The infection was cured after total removal of the instrument and intravenous antibiotic therapy. <Conclusion> Anterior instrumentation fixation was superior to posterior fixation in radiographical recovery of kyphosis in midthoracic lesions. There were no differences in bony fusion rate and neurological outcome between anterior and posterior fixation.

Aseptic Loosening After CD Instrumentation in the Treatment of Scoliosis

We report eight patients who had had operative treatment of idiopathic scoliosis with CD instrumentation and developed radiolucency around pedicle screws and a discharging sinus. There are two recent reports (Dubousset J, Shuffleberger H, Wenger D. Late infection with CD instrumentation. Orthop Trans 18:121, 1994; Richards BS. Delayed infections following posterior spinal instrumentation for the treatment of idiopathic scoliosis. J Bone Joint Surg [Am] 4:524-529, 1995) describing delayed infection with spontaneous drainage after the treatment of scoliosis with CD instrumentation and Texas Scottish Rite Hospital system with controversial results. Eight patients had radiologic signs of implant loosening after a mean of 7 months, with radiolucency around the pedicle screws. Six patients developed a painful swelling and a discharging sinus after a mean of 21 months. Histopathologic results showed metal wear and chronic inflammatory reaction with granuloma formation. No evidence of pyogenic infection was present. We believe that this complication is caused by micromotion.

Efficacy of pedicle screw fixation in the treatment of spinal instability and failed back surgery: a 5-year review.

The goal of this study was to review retrospectively the outcome of 95 patients with various disorders leading to instability of the thoracolumbar and lumbar spine who were treated consecutively via a posterior surgical approach with pedicle screw fixation in which the Texas Scottish Rite Hospital system was used. All cases were managed according to the same protocol. Follow-up review averaged 29.6 months. Radiographic evidence of osseous union and the patient's current status were analyzed. Four screws were malpositioned, and there were two dural lacerations of a nerve root and one pedicle fracture. Deep wound infections developed in five patients (5.2%), and three patients had postoperative radicular pain. In one case, the rods disengaged from the screws; in four cases, hardware was removed but there were no broken screws. Neurological deficits improved in 85% of the surviving patients, and no patient was worse neurologically after surgery. The rate of osseous union was 96.8%. Three patients developed pseudarthrosis, one of whom was asymptomatic. Back pain improved in 80 patients. A solid bone fusion, however, was not necessarily associated with decreased back pain. These results support the use of pedicle screw fixation as an effective and safe procedure for fusion of the thoracolumbar and lumbar spine and support the finding that complications can be minimal when a meticulous surgical technique is used. The proper selection of patients for surgery is probably the most important factor associated with good outcomes.

Efficacy of pedicle screw fixation in the treatment of spinal instability and failed back surgery: a 5-year review

Object The goal of this study was to review retrospectively the outcome of 95 patients with various disorders leading to instability of the thoracolumbar and lumbar spine who were treated consecutively via a posterior surgical approach with pedicle screw fixation in which the Texas Scottish Rite Hospital system was used. Methods All cases were managed according to the same protocol. Follow-up review averaged 29.6 months. Radiographic evidence of osseous union and the patient's current status were analyzed. Four screws were malpositioned, and there were two dural lacerations of a nerve root and one pedicle fracture. Deep wound infections developed in five patients (5.2%) and three patients had postoperative radicular pain. In one case, the rods disengaged from the screws; in four cases, hardware was removed but there were no broken screws. Neurological deficits improved in 85% of the patients and no patient was worse neurologically after surgery. The rate of osseous union was 96.8%. Three patients developed pseudarthrosis, one of whom was asymptomatic. Back pain improved in 80 patients (85%). A solid bone fusion, however, was not necessarily associated with decreased back pain. Conclusions These results support the use of pedicle screw fixation as an effective and safe procedure for fusion of the thoracolumbar and lumbar spine and support the finding that complications can be minimal when a meticulous surgical technique is used. The proper selection of patients for surgery is probably the most important factor associated with good outcomes.

Decompression in the Surgical Management of Degenerative Spondylolisthesis

The management of degenerative spondylolisthesis with laminectomy alone or laminectomy with fusion remains controversial. From the early 1970s to 1996, 290 patients with degenerative spondylolisthesis were treated with 249 laminectomies and 41 fenestration procedures over an average of 3.2 levels. One level olisthesis was encountered in 250 patients, and two levels of slip in 40. Patients averaged 67 years of age, and were followed an average of 10 years. Using Prolo's outcome scale, 69% of patients exhibited excellent, 13% good, 12% fair, and 6% poor outcomes. Secondary decompressions with fusions for increased olisthy/instability (five patients) and recurrent stenosis/disc disease/instability (three patients) required one posterolateral "in situ" fusion and seven Texas Scottish Rite Hospital instrumented procedures. Decompression alone successfully managed degenerative spondylolisthesis in 290 patients treated over 3 decades, because only 8 (2.7%) required secondary fusion.

Multiple Tarsal Coalitions in the Same Foot

I reviewed 60 cases of tarsal coalition seen at Texas Scottish Rite Hospital for Children over the last 10 years. Twenty-nine patients had plain films only and were excluded from the study. One patient was diagnosed with synovitis at the time of surgery and was also excluded. Thirty patients with 53 coalitions had computed tomographic (CT) and, in many cases, surgical documentation of a tarsal coalition. Of these 30 patients, six had multiple coalitions in the same foot. This article briefly summarizes the six cases and reviews the literature of multiple tarsal coalitions, both before and after the use of CT. I suggest that multiple coalitions in the same foot are more common than once thought and recommend CT evaluation of both feet in transaxial and coronal planes in patients with suspected tarsal coalition.

Use of the Forte Plate in Unstable, Dorsally Displaced Fractures of the Distal Radius

Eastwood Orthopaedic Clinic Auckland. New Zealand (BROWN) Texas Scottish Rite Hospital, Dallas, Texas, U.S.A. (CARTER) Address correspondence and reprint requests to Dr. Peter R. Carter, Texas Scottish Rite Hospital, 2222 Welborn, Dallas, TX 75219, U.S.A.

Use of the Texas Scottish Rite Hospital instrumentation in the treatment of thoracolumbar injuries.

This is a prospective study of the results of the use of Texas Scottish Rite Hospital instrumentation for thoracolumbar and lumbar injuries. To make an objective assessment of the clinical and radiologic results, the second and the third authors were used as unbiased assessors. To evaluate the short-term results of the use of Texas Scottish Rite Hospital instrumentation in thoracolumbar injuries. To the authors' knowledge, there are only a few reports concerning the use of the Texas Scottish Rite Hospital instrumentation for stabilization of the spine, mostly in scoliosis and degenerative spine disease, and only one report on use of this instrumentation in thoracolumbar injuries. Forty patients, with an average age of 45 years, who suffered from 48 thoracolumbar spinal fractures and dislocations, underwent posterior Texas Scottish Rite Hospital hook-rod instrumentation by means of "double-claw" configuration, two levels above and two below the lesion level for reduction of the injury, and stabilization and restoration of the sagittal profile of the thoracolumbar spine. Roentgenograms and computed tomography scans were evaluated on the basis of the same protocol before and after surgery and in follow-up observation. All patients were followed for an average period of 32 months. The sagittal profile of the thoracolumbar spine was restored significantly. No patient had neurologic deterioration after surgery, and all patients with incomplete lesions improved postoperatively at least one Frankel grade. One hook dislodgment was observed in one patient without loss of correction or non-union. There was only one deep infection. With the Texas Scottish Rite Hospital instrumentation, it was possible to provide solid internal fixation with restoration of the sagittal profile without loss of correction.

Prevalence of segmental wire breakage using Cotrel-Dubousset instrumentation in the management of idiopathic scoliosis.

This is a retrospective radiographic and medical record analysis of 77 patients. To determine whether there is an increased prevalence of segmental sublaminar wire breakage associated with the knurled (diamond) pattern machined onto the Cotrel-Dubousset rod as opposed to a smooth rod. Segmental fixation of vertebral segments with sublaminar wires is a common surgical technique, and the use of sublaminar wires with a knurled Cotrel-Dubousset rod theoretically could cause premature wire breakage. Sixty-six patients with idiopathic scoliosis had the Cotrel-Dubousset (knurled rod) system and comprised the study group, and the Texas Scottish Rite Hospital system (smooth rod) was placed in 14 patients, who served as a control group. Serial radiographs after 3, 6, 12, and 24 months were reviewed. All patients had augmentation of their scoliosis constructs with 16-gauge sublaminar wires in the lumbar spine. Minimum follow-up period was 24 months. No wire breakage was noted in any patient. There is no increased likelihood that the knurled rod pattern will cause wire breakage, provided a solid fusion is obtained.

CARRELL-KRUSEN SYMPOSIUM, Texas Scottish Rite Hospital for Children, Dallas, Texas, February 27-28, 1997

The Carrell-Krusen Symposium was established in 1977 by Dr Jay Cook, who was the Director of Pediatric Neurology at Texas Scottish Rite Hospital for Children until 1989. The Symposium was named after Dr Brandon Carrell, son of the founder of Texas Scottish Rite Hospital for Children, and Dr Edward Krusen, the first Muscular Dystrophy Association Clinical Director for the city of Dallas. In 1990, Dr Susan Iannaccone became the Symposium Director, and since then, the focus of the meeting has been the treatment of neuromuscular disease, with an emphasis reflecting the changes in clinical practice. The invited Carrell-Krusen Visiting Professors are world renowned for their work in neuromuscular disease.

Versatility of TSRH spinal instrumentation system

We evaluated the effectiveness of the TSRH (Texas Scottish Rite Hospital) spinal instrumentation system in treating patients with spinal deformities and trauma to the spine. 38 patients (29 women) with spinal deformities and 29 (13 women) with trauma to the spine underwent fusion using the TSRH implant system. In patients with idiopathic scoliosis, the amount of curve correction achieved varied depending on the curve pattern, where patients with single thoracic (type III) or single extended thoracic (type IV) curves showed an improvement of 54% and 63%, respectively, compared to patients with King type II curves in which correction averaged only 45%. We found the TSRH spinal system to be effective for correcting the scoliotic curve. The fact that no neurologic complications were observed and that patients demonstrated a rapid ability to stand and walk as compared to the lengthy immobilization required with more traditional methods, suggests that the TSRH system is superior for scoliotic curve correction.