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Steven W. Hwang, Amer F. Samdani, Baron S. Lonner, Michelle C. Marks, Tracey P. Bastrom, Randal R. Betz and Patrick J. Cahill

not find any reported formula based on or correlated to clinical postoperative values. Several studies have used radiographic measures and stereomorphometric parameters to estimate height loss from scoliosis, but none have correlated clinical outcomes with predicted equations. 2–4 , 9 Bjure et al. 2 first attempted to predict the amount of height loss from scoliotic deformity as an assessment of lung function. However, they did not account for radiographic magnification or sagittal plane alignment in their series. Bjure et al. concluded that the loss of height

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Ali A. Baaj, Douglas Brockmeyer, Andrew Jea and Amer F. Samdani

P ediatric spinal deformity is a rapidly evolving field with increased interest and participation from the neurosurgical community. In recent years we have seen several improvements, including an enhanced understanding of the importance of imparting thoracic kyphosis in patients with adolescent idiopathic scoliosis (AIS), advances in neuromonitoring and responding to changes, the introduction of magnetically controlled growing rods, and important progress in identifying and preventing complications, to name a few. This issue of Neurosurgical Focus begins with

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Joseph Ferguson, Steven W. Hwang, Zachary Tataryn and Amer F. Samdani

the use of IONM, the surgeon is notified of potential injury to the spinal cord earlier, thus allowing for more effective management and avoidance of potential permanent neurological insults. IONM is now commonplace in the management of deformity correction surgery. 3 Intraoperative neuromonitoring consists of several modalities that provide information regarding the physiological function of the spinal cord while the patient undergoes surgical deformity corrective procedures, and it has been validated as a monitoring system to minimize iatrogenic spinal cord

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Maria Zuccaro, James Zuccaro, Amer F. Samdani, Joshua M. Pahys and Steven W. Hwang

I n the United States, the vast majority of pediatric deformity surgeries are performed while using intraoperative neuromonitoring (IONM). If reliable transcranial electric motor evoked potentials (TceMEPs) are present, they can be used intraoperatively as a substitute for performing the wake-up test. 1 However, multiple factors may influence the ability to generate baseline evoked potentials in certain pediatric populations. 1 , 2 , 12 Because of their associated risks of complete or partial paralysis, surgical procedures that may benefit from the use of

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Ajit Jada, Charles E. Mackel, Steven W. Hwang, Amer F. Samdani, James H. Stephen, James T. Bennett and Ali A. Baaj

A dolescent idiopathic scoliosis (AIS) is one of the most commonly treated types of scoliosis. We here summarize the classification, evaluation, and management of AIS and briefly discuss more subtle aspects of clinical care. Etiology and Pathogenesis Adolescent idiopathic scoliosis is a 3D spinal deformity that can involve one or more segments of the thoracolumbar vertebral column, 19 , 61 affects children between the ages of 11 and 18, 27 and is of unknown etiology. In the simplest terms, scoliosis is described as lateral curvature of the spine > 10° with a

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Editorial

Infantile idiopathic scoliosis

Mark F. Abel

adolescent idiopathic scoliosis is not a trivial condition, but the health consequences are relatively minor, including spinal deformity and back pain as an adult. On the other hand, the progressive forms of IIS can lead to thoracic insufficiency and cor pulmonale, with premature death in adulthood in addition to the deformity and pain. The obvious difference is that in IIS, these young patients have only started lung and chest development, and deformity progression occurs throughout a much longer period of growth. Thus, medical management of IIS has been one of the

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Andrew Jea

Ferguson et al. present a well-written study analyzing a subset of 47 cases (out of an impressive 519 cases over a 3-year period) involving patients in the pediatric age group who experienced changes in intraoperative neurophysiological monitoring, or intraoperative neuromonitoring (IONM), while undergoing spinal deformity surgery at Shriners Hospital for Children in Philadelphia. 4 The authors, particularly the senior authors Drs. Steven Hwang and Amer Samdani, represent “the few and the proud” pediatric neurosurgeons who not only have a strong interest

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Steven W. Hwang, Amer F. Samdani, Ben Wormser, Hari Amin, Jeff S. Kimball, Robert J. Ames, Alexander S. Rothkrug and Patrick J. Cahill

E arly instrumented correction of scoliotic deformities largely involved Harrington rod instrumentation. 9 , 10 Harrington rod distraction helped improve the coronal deformity but did not surgically address the sagittal or axial plane, and has thus been associated with a higher incidence of flatback syndrome. 5 , 6 , 35 The advent of Cotrel-Dubousset instrumentation significantly advanced surgical management of AIS by allowing surgical therapy to address all 3 planes of deformity. However, the impact of Cotrel-Dubousset instrumentation on axial deformity

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Steven W. Hwang, Amer F. Samdani and Patrick J. Cahill

I diopathic scoliosis is a pathological process that affects the spinal column in all 3 dimensions. 18 Relative lordosis of the thoracic spine contributes to spinal column deformity in the sagittal, coronal, and axial planes that often leads to rib cage asymmetry. 4 Although the pathophysiology of idiopathic scoliosis remains unclear, significant treatment advances have been made. In 1995, Suk et al. 20 described the application of thoracic pedicle screw constructs in the correction of scoliosis. Although many surgeons were initially wary of the

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Daniel J. Cognetti, Amer F. Samdani, Joshua M. Pahys, Mari L. Groves and Steven W. Hwang

T he management of severe scoliosis in young children is complicated by 2 problems with conflicting solutions: the need for deformity correction and the need for continued longitudinal growth. Normal development and function of thoracic and abdominal organs relies in part on proper development of the vertebral column; however, definitive spinal fusion to correct deformity halts longitudinal growth, while more conservative management methods that allow growth, like bracing, may not adequately address the deformity. 2 , 6 , 11 Growing rods and their many variants