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spinemonitor: Neck & Back Pain eNewsletter from February 27, 2008
This edition of spinemonitor features two outstanding cases.  Timothy R. Kuklo, MD, JD presents a case of a 16-year-old with a grade 3 spondylolisthesis.  Discussion of Dr. Kuklo’s case is provided by Neel Anand, MD, Mch Orth.  Next, Charles E. Johnston, MD brings insight into the treatment of a 5-year-old with increasing spinal deformity.  Behrooz A. Akbarnia, MD has provided an in-depth discussion of Dr. Johnston’s case.
New Case Study
16-Year-old with Grade 3 Spondylolisthesis
Timothy R. Kuklo, MD, JD Case Author:
Timothy R. Kuklo, MD, JD
Associate Professor
Orthopaedic Surgery and Neurological Surgery
Washington University School of Medicine
St. Louis, MO
The patient is a 16-year-old female presenting with back pain, hamstring tightness, and increasing leg pain, with pain in the left leg greater than in the right.

Physical Examination:
Patient has normal coronal and sagittal balance, in addition to a normal neurologic exam.  She has positive left straight leg raise.

Prior Treatment:
Previously, the patient has tried physical therapy.

Featured to the right is a preoperative standing (Fig. 3)...

The patient was diagnosed with Grade 3 isthmic spondylolisthesis...Read Complete Case, Vote for Treatment, and View Outcome

16-Year-old with Grade 3 Spondylolisthesis

Fig. 3: Preoperative standing
Click here for Larger Images

How Would You Treat this Patient?
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Past Spine Cases:
Below is a listing of previous spine case studies. Feel free to browse and vote for treatment options for each case.
L1 Burst Fracture: Bracing or Surgery?
By: Lali Sekhon, MD, PhD, FRACS, FICS

Adolescent Disc Herniation: Conservative or Surgical Treatment?
By: Reginald Q. Knight, MD

Severe Low Back Pain in a 90-Year Old Male
By: Steven Richeimer, MD

Adjacent Segment Degeneration after Previous Decompression and Fusion
By: David W. Polly, Jr., MD

Degenerative Disc Disease
By: David W. Polly, Jr., MD

Cervical Pseudoarthrosis and Adjacent Level Disease
By: Jason M. Highsmith, MD

Adult Onset Scoliosis
By: Amir A. Mehbod, MD

Spinal Stenosis – Unresponsive to Nonoperative Treatment
By: Jason M. Highsmith, MD
Featured Article
Growing Spine Case: 5-Year-old with Increasing Spinal Deformity

Charles E. Johnston, MD
Assistant Chief of Staff and Medical Director of Research
Texas Scottish Rite Hospital for Children
Dallas, TX

A 5-year-old male, with an uncharacterized congenital myopathy, presented for increasing spinal deformity. He was ambulatory, but was having some recent “balance” issues, which the parents reported as frequent falling due to spinal and trunk imbalance, although the patient was also afflicted with “unstable” knees, for which he wore braces to aid stability.  

The patient’s family history was notable for an older sibling with a similar myopathy, who was more severely involved and currently wheelchair bound. His review of systems was otherwise unremarkable, and there was no history of respiratory impairment, frequent upper respiratory infections, or other infections. A brace had been prescribed by another physician, but was not tolerated due to pain from pressure over the rib prominence.

View Complete Article

Featured Event
Sharpening Your Spine Surgery Skills: A Hands-on Cadaveric Course

April 18-19, 2008
The Westin Lombard and The Spine Masters Institute Burr Ridge, IL (Chicago suburbs)

Keith H. Bridwell, MD
William C. Horton, III, MD
Richard G. Fessler, MD
David W. Polly, Jr., MD
Harry L. Shufflebarger, MD

In two days of hands-on cadaveric labs (10+ hours) and lectures, the course will update you on the latest spine techniques and technologies, including cervical arthroplasty, osteotomies (VCRs, PSOs), minimally invasive techniques, and regional fixation—cervical to sacrum. A faculty of 14 leading orthopaedic and neurological surgeons lead the course for orthopaedic and neurological surgeons, residents and fellows.

The Westin Lombard, Burr Ridge, IL

View Event Details
Featured Online CNE Program
Scoliosis and Spinal Deformity: Diagnosis to Treatment
Receive 1.0 Contact Hour Upon Completion

This online continuing education program is designed to provide nurses and allied health professionals with a comprehensive overview of scoliosis and spinal deformity from "A-Z." The program, which should take approximately one-hour to complete, covers: Spinal anatomy, scoliosis in children and adults, radiographic and other imaging, curve measurement and classification, nonsurgical and surgical treatment, and postoperative care.

Upon completion of this program, participants should be able to:

  • Discuss basic spinal anatomy and its relationship to scoliosis
  • Provide information about different types of scoliosis and possible causes
  • Explain key diagnostic tests and methods related to curve assessment
  • Identify nonoperative and age-specific treatment and goals
  • Describe the history and advances of scoliosis surgery, including current approaches and procedures
  • Summarize pre-operative imaging, tests and surgical risks
  • Improve postoperative care of scoliosis patients

Scoliosis CNE Activity

Begin Activity

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