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Biomedical subjects

J P Lubicky

Publications and source records attributed to J P Lubicky.

At least 19 recordsLinked to original sources
PubMed1999

The halo-Milwaukee brace. Case series of a revived technique.

STUDY DESIGN: A case series in which the halo-Milwaukee brace was used for postoperative immobilization in children with complex congenital and developmental spinal deformities. OBJECTIVES: To describe the use of halo-Milwaukee orthosis in a pediatric population for stabilization of the cervical and upper thoracic spine. SUMMARY AND BACKGROUND DATA: Postoperative immobilization of the neck and upper thorax can be achieved with cervical orthoses, cervicothoracic lumbar orthosis, halo cast, Minerva jacket, or halo vest. In the young child or in individuals with severe deformities, prefabricated braces often do not provide adequate stability or predictable fit. The halo-Milwaukee brace has proven to be an effective and versatile technique in the management of complex pediatric spinal deformities. METHODS: Halo-Milwaukee brace immobilization was used in 12 patients after surgical stabilization of the upper thoracic or cervical spine. Technique and indications are discussed in this report. Surgical outcomes and complications were reviewed retrospectively in all cases. RESULTS: Application of the halo-Milwaukee brace was a clinically effective and safe means of controlling the upper thoracic and cervical spine. The orthosis was well tolerated and allowed access to the posterior incision. The brace is easily converted to a standard Milwaukee brace with neck ring. The pelvic segment of the brace is molded before surgery, and in most instances did not require postoperative modification. CONCLUSION: The halo-Milwaukee brace is a simple and convenient method of intraoperative and postoperative immobilization. The technique is applicable in patients who cannot be treated with more conventional off-the-shelf orthoses. The brace was well tolerated and allowed for early patient mobilization.

Adolescent↗
PubMed1998

Long-term outcomes and life satisfaction of adults who had pediatric spinal cord injuries.

OBJECTIVE: To determine long-term outcomes and life satisfaction of adults who sustained pediatric spinal cord injury (SCI). DESIGN: Structured interview of adults who were 25 years or older who had pediatric SCI. SETTING: Community. PARTICIPANTS: A convenience sample of 46 patients from a total of 81 patients who received care in an SCI program: 1 refused participation, 4 died, and 30 were lost to follow-up. MAIN OUTCOME MEASURES: A structured questionnaire including physical, psychosocial, and medical information. The Craig Handicap Assessment and Reporting Technique and two measures of life satisfaction were also administered. RESULTS: Participants were 25 to 34 years old, mean 27 years. Thirty-two had tetraplegia and 14 had paraplegia. Thirty-one were men. Mean years of education was 14. Fifty-four percent were employed, 48% lived independently, and 15% were married. Life satisfaction was associated with education, income, satisfaction with employment, and social/recreation opportunities, and was inversely associated with some medical complications. Life satisfaction was not significantly associated with level of injury, age at injury, or duration of injury. CONCLUSIONS: Individuals who had pediatric SCI, much like adult-onset SCI, have the greatest opportunity for a satisfying adult life if rehabilitation emphasizes psychosocial factors such as education, employment, and long-term health management.

Activities of Daily Living↗
PubMed1997

Cervical spine fusion: not protective of cervical spine injury and tetraplegia.

The occurrence of tetraplegic spinal cord injuries in two patients who had preexisting cervical spine fusions highlights the vulnerable nature of such patients. One patient sustained a C5-6 fracture-dislocation after a motor vehicle accident, despite a spontaneously fused cervical spine as a consequence of his juvenile rheumatoid arthritis. A second patient sustained a C3-4 distraction injury in a sporting injury 2 years after he had undergone a posterior cervical spine fusion because of an aneurysmal bone cyst. Prior to their spinal cord injuries, both patients had no apparent neurologic deficits, were relatively active, and followed no specific precautions for their spines.

Adolescent↗
PubMed1996

Neurologic and vascular complications of scoliosis surgery in patients with Ehlers-Danlos syndrome. A case report.

STUDY DESIGN: Case reports. OBJECTIVES: Description of neurologic and vascular complications of scoliosis surgery to children and adolescents with ehlers-danios syndrome. SUMMARY OF BACKGROUND DATA: There have been no previous reports of neurologic and vascular complications of scoliosis surgery in patients with Ehlers-Danlos syndrome. Scoliosis and vascular fragility are characteristics of certain types of Ehlers-Danlos syndrome. METHODS: Case reports and literature review. RESULTS: Subsequent to scoliosis surgery, three patients with Ehlers-Danlos syndrome developed neurologic complications: two developed paraplegia, and one developed unilateral foot and ankle weakness with transient neurogenic bladder. Another patient with Ehlers-Danlos syndrome experienced avulsion of segmental arteries during anterior spinal surgery. CONCLUSIONS: Patients with Ehlers-Danlos syndrome may be at high risk for neurologic and vascular complications consequent to scoliosis surgery, necessitating careful perioperative evaluation and management.

Cardiovascular Diseases↗
PubMed1996

Arthrographic evaluation of developmental dysplasia of the hip. Outcome prediction.

Arthrograms of 35 hips in 33 children less than 2 years of age with typical development dysplasia of the hip were reviewed. After arthrograms were repeated for 11 hips 6 weeks following the initial test, results were classified into 6 types based on medial pooling ratio and morphology of the acetabular limbus. Using modified Severin's criteria for outcome evaluation, 7 of the 11 hips had been upgraded in type. All hips that were classified as Type I by arthrogram had Severin I results. The relation of arthrographic type and radiographic results was statistically significant. Immediate open reduction is recommended in hips classified as Type VI at first arthrogram or Type III and above at repeat arthrogram.

Arthrography↗
PubMed1996

Chondrolysis and avascular necrosis: complications of slipped capital femoral epiphysis.

Chondrolysis and avascular necrosis (AVN) are serious complications after slipped capital femoral epiphysis (SCFE). Chondrolysis, or acute cartilage necrosis of the capital femoral epiphysis, can occur in treated and untreated SCFE. Its exact etiology has not been conclusively determined, and there may be some connection with hardware penetration into the joint and its development. Because chondrolysis can occur in both treated and untreated hips, an immune mechanism has been postulated. Although some evidence of immune reaction has been confirmed in the joint, no screening test has yet been developed to determine susceptible individuals. AVN is clearly related to impeded blood supply to the femoral head and to severely slipped unstable acute slips. Forceful reduction of the femoral head must be avoided. However, some slips are so unstable that reductions occur merely with positioning of the patient for operation. Improperly placed fixation devices may also play a role in the development of AVN. Chondrolysis and AVN may not be completely avoidable in the treatment of SCFE.

Animals↗
PubMed1995

Ambulation with parapodia and reciprocating gait orthoses in pediatric spinal cord injury.

The use of parapodia and reciprocating gait orthoses (RGOs) was reviewed in 41 children and adolescents with spinal cord injuries. Compared with users of RGOs, users of parapodia were younger when injured and when the orthotic was first used, were more likely to be household ambulators and to have higher neurological levels, and were unlikely to continue their use of the parapodium after early school age. Hip contractures that required surgical releases or contributed to discontinuation of orthotic usage were present in six of 26 parapodium users and 12 of 22 RGO users. RGOs and parapodia have a limited but important role in management of pediatric spinal cord injury, and should be used in a developmentally based program responsive to the changing needs of children and adolescents.

Child↗
PubMed1995

Clubfoot deformity in Down's syndrome.

The association of Down's syndrome (trisomy 21) with clubfeet has not previously been elaborated. Eight patients with a total of 15 clubfeet were identified for review. Five of these had trisomy 21 noted by chromosomal analysis, and 1 had a mosaic pattern. Two patients did not have chromosomal documentation, but had characteristic features of Down's syndrome. Interestingly, 2 patients had evidence of arthrogryposis as well as Down's syndrome. Four of the 8 patients had other orthopedic anomalies, including scoliosis, atlantoaxial instability, brachydactyly, and coxa valga. All 8 patients had an initial period of casting prior to any surgical intervention. Fourteen of the 15 feet required surgical intervention to afford correction of the deformity. The 6 feet with relatively long-term follow up (average: 5 years) showed that there was 1 excellent, 4 good, and 1 fair result using the criteria of Turco. It appears that, even though Down's syndrome is usually characterized by ligamentous laxity, when clubfeet are associated with this syndrome they are often resistant to nonoperative treatment, and surgical treatment seems to produce an acceptable result.

Casts, Surgical↗
PubMed1994

Spinal deformity in Charcot-Marie-Tooth disease.

STUDY DESIGN: This retrospective study reviewed 100 children with clinically and electrodiagnostically proven Charcot-Marie-Tooth disease (CMTD). OBJECTIVE: To determine the incidence of spinal deformity in children with CMTD. SUMMARY OF BACKGROUND DATA: A 10% incidence of kyphoscoliosis has been reported. METHODS: All charts and electrodiagnostic studies were reviewed to confirm that CMTD diagnostic criteria were met. Existing radiographs on 89 children were available. Cobb angles were measured and deformity was defined as scoliosis > or = 10 degrees and kyphosis > 40 degrees. RESULTS: Thirty-seven of 89 CMTD children had spinal deformity. There was scoliosis in 20, kyphoscoliosis in 14, and kyphosis in 3. In children with radiographs taken at maturity, 50% had deformity. The most common scoliotic pattern was a thoracic curve with convexity in either direction. Spinal deformity is more likely in female and Type I patients. CONCLUSIONS: This study found an incidence of 37%-50% spinal deformity in children with CMTD, with female and Type I patients at greatest risk. However, the deformity rarely required treatment.

Adolescent↗
PubMed1994

Kyphectomy and segmental spinal instrumentation in young children with myelomeningocele kyphosis.

For children with myelomeningocele kyphosis, the ideal timing for spinal correction or the correct stabilization technique for preventing the recurrence of deformity are controversial issues. From 1988 to 1992, vertebral kyphectomy and long segment spinal fixation with a special lower-end contouring around the anterior aspect of the sacrum through the sacral foramina (the modified Gillespie's technique) were carried out on six young children with ages ranging from three years and four months to five years and 11 months (average, five years). The indications for surgery were recurrent skin breakdown and/or increasing functional deficits due to curve progression. A mean preoperative kyphosis of 126.3 degrees was reduced to 21.8 degrees postoperatively. There was one case of pseudarthrosis seen at the osteotomy site which was treated with anterior interbody grafting. With a mean follow-up period of 35 months (range, 10-48 months), all patients showed good maintenance of correction and no implant failure. The average loss of correction was 2.7 degrees. We believe that in these young, severely handicapped children, long segment fixation using the modified Gillespie's technique with full or partial segment fusion allows a quick resumption of upright activities, achieves satisfactory correction of kyphosis and minimizes the risk of recurrent deformity.

Child, Preschool↗
PubMed1994

Scoliosis in Rett syndrome.

Scoliosis is the most common orthopaedic problem encountered in Rett syndrome. It is characterized by a long C-shaped thoracolumbar curve of neurologic origin. The occurrence of scoliosis in Rett syndrome is age-dependent, with a reported incidence of 36% to 100%. The onset of scoliosis is usually before age 8 years, and rapid curve progression is usually detected early in the second decade. In Rett syndrome, sagittal deformity with excessive kyphosis can progress and necessitates close observation. Orthotic treatment does not alter the natural history of scoliosis or kyphosis. Indications for surgery are curve progression exceeding a 40 degree or 45 degree Cobb angle or curves that cause pain or loss of function. Anterior discectomy, interbody fusion, and posterior fusion with instrumentation can achieve improved correction in young adolescents with significant curves. Surgical intervention should include fusing the scoliotic and the excessively kyphotic segments.

Adolescent↗
PubMed1993

Further delineation of spondylo-meta-epiphyseal dysplasia, short limb-abnormal calcification type, with emphasis on diagnostic features.

Further delineation of a generalized bone dysplasia which we call spondylo-meta-epiphyseal dysplasia, short limb-abnormal calcification type is presented. This dwarfing condition has several serious complications, with the most common cause of death being spinal cord damage secondary to atlantoaxial instability. It is a heritable condition with an autosomal recessive mode of transmission. Radiologic diagnostic criteria are developed on the basis of studies in 8 patients with the oldest being between 4 and 5 years old. The condition is clinically and radiographically apparent neonatally or in early infancy, and it is probable that all or almost all affected individuals will come to medical attention in the age range screened by this study.

Abnormalities, Multiple↗