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Pediatric Spine Program Research & Teaching

Pediatric Spine Program Research

At Shriners Hospitals for Children — Northern California, specialists care for a high volume of pediatric patients with spine disorders and many patients with rare conditions. This positions the Pediatric Spine Program for research studies not widely possible at other institutions. Through clinical trials and retrospective studies at a single location, specialists have made significant contributions to the treatment of scoliosis and other disorders.

Treating Scoliosis with Intra-operative Traction during Spinal Fusion

Our team studied the efficacy of cranio-femoral traction in adolescents with moderate scoliosis by reviewing medical chart and radiograph data from 73 patients at the Northern California Shriners Hospital. Of the cohort, 36 patients underwent posterior spinal fusion with intra-operative traction, while 37 did not receive traction. Traction in fusions less than eight levels resulted in decreased blood loss, shorter operative time and greater degree of curve correction. Lenke 1 curves treated with intra-operative traction demonstrated greater curve correction and shorter operative time. As a result, the team recommended strong consideration be given to the use of intra-operative cranio femoral traction, especially in the setting of selective fusions for Lenke 1 curves.

Scoliosis Surgery and its Effect on Pulmonary and Cardiac Function in Patients with Duchenne Muscular Dystrophy

This study provided valuable insight regarding the effect of scoliosis stabilization surgery on pulmonary and cardiac function loss in patients with Duchenne Muscular Dystrophy. The study took a retrospective review of 80 patients at Shriners Hospitals for Children — Northern California. The team concluded that operative treatment of scoliosis in patients was not associated with a significantly higher rate of pulmonary function decline following the Luque Galveston surgical technique for scoliosis correction. The results of this study were published in Spine.

Comparing Implant Densities for Optimal Correction of Scoliosis

Published in World Neurosurgery, this study compared radiographic results between high- and low-density implants in patients with large, rigid spinal curves who had already undergone anterior release and posterior spinal fusion. Researchers reviewed cases performed over a nine-year period at Shriners Hospitals for Children — Northern California. The research team discovered a statistically significant improvement in correction in the high-implant density group.

Traditional Growing Rod Implantation: Risk-Benefit Analysis of Surgical Intervention

In this study, researchers reviewed 29 patients who underwent treatment for early onset scoliosis at Shriners Hospitals for Children — Northern California. Patient demographics, number of imaging procedures, anesthesia time, and surgical complications were all acquired from patient medical records, illuminating complications and other potential risks of growing rod implantation. The research team conducted a risk-benefit analysis of each procedure and developed a model to aid in shared-decision making of initiating, continuing and completing treatment.

Treating Severe Scoliosis with Combined Anterior Release and Posterior Spinal Fusion versus Posterior-Only Spinal Fusion with Intraoperative Halo-Femoral Traction

This study assessed the effectiveness of two treatment options for severe idiopathic scoliosis:

  • Posterior-only spinal fusion with intraoperative halo femoral tract (PSFT)
  • Anterior release and posterior spinal fusion (APSF)

The team examined degree of curve correction, blood loss and rate of complications. Both groups achieved similar curve correction, but the higher beginning curve magnitude in the APSF group may have led to greater final curve correction. The APSF group was also associated with a higher respiratory complication rate and longer stay in ICU. Surgeons and families can consider these data when making surgical decisions.

Spinal Procedure Infection Rates with Various Agents

At Shriners Hospitals for Children — Northern California, researchers compared infection rates after spinal surgery over an eight-year period for 475 pediatric patients. Cohorts received no intervention, intrawound Vancomycin, Povidone-iodine irrigation, or a combination of intrawound Vancomycin and Povidone-iodine irrigation. Results demonstrated that the combined approach was associated with the lowest infection rate for their patient. The team recommended that this strategy be considered in all pediatric patients undergoing spinal deformity procedures. A manuscript was presented at the American Academy of Orthopedic Surgery meeting in March 2018 and submitted to Spine Deformity Journal.

Orthopedic Residencies and Fellowships

Residencies

Three orthopedic surgery residency programs send their physicians to Shriners Hospitals for Children — Northern California for pediatric orthopedics training:

  • University of California Davis (UC Davis): 10 residents per year
  • University of California San Francisco: Seven residents per year
  • San Francisco Orthopedic Residency Program: Six residents per year

In addition, UC Davis sends 11 Pediatrics and four Physical Medicine and Rehabilitation residents to the Northern California Shriners Hospital annually for pediatric orthopedics and rehabilitation residency training.

Fellowships

Shriners Hospitals for Children — Northern California participates in several fellowship programs.

  • Pediatric Orthopedics: This year-long fellowship, credentialed by the Pediatric Orthopedic Society of North America, is sponsored by Shriners Hospitals for Children — Northern California. Fellows spend most of their year here, and also rotate through two other centers: UC Davis Health and University of California San Francisco Benioff Children’s Hospital.
  • Pediatric Hand Surgery: This six-month fellowship for surgeons who have already completed hand surgery training and wish to subspecialize in pediatric hand surgery is sponsored by Shriners Hospitals for Children — Northern California. In addition, hand surgery fellows from University of California San Francisco and UC Davis rotate through the Northern California Shriners Hospital annually in order to learn about the care of pediatric hand problems.
  • Spine surgery and Physical Medicine and Rehabilitation fellows from UC Davis rotate through Shriners Hospitals for Children — Northern California each year.