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Sandi K. Lam, Christina Sayama, Dominic A. Harris, Valentina Briceño, Thomas G. Luerssen, and Andrew Jea

unlimited quantity and immediate availability make it useful in certain pediatric spine applications, although its cost may be prohibitive in some settings. There are concerns regarding the routine and so-called off-label substitution or supplementation of autologous or allograft bone graft with rhBMP-2. The most significant concerns involve the possibility of bony overgrowth, interaction with exposed dura mater, cancer risk, systemic toxicity, local toxicity, immunogenicity, osteoclastic activation, and effects on distal organs. 44 The issue of whether rhBMP-2 is an

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Sheila L. Ryan, Anish Sen, Kristen Staggers, Thomas G. Luerssen, and Andrew Jea

P erioperative surgical site infections (SSIs) after pediatric spine fusion are well-described complications with rates ranging from 0.5% to 1.6% in idiopathic scoliosis to 3.7% to 8.5% in combined idiopathic and nonidiopathic scoliosis series. 4 , 12 , 14–16 , 21 Some patient cohorts are at an increased risk for SSIs after spinal fusion; SSI rates for patients with spinal dysraphism range from 8% to 41.7%, and for those with cerebral palsy range from 6.1% to 15.2%. 1 , 2 , 6 , 9 , 17 , 19 , 20 Surgical site infections impart a tremendous burden on the

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James L. West, Madison Arnel, Atilio E. Palma, John Frino, Alexander K. Powers, and Daniel E. Couture

indications for pediatric spinal surgery as well as the anatomical landscape of pediatric spine surgery are quite different than those for the majority of adult cases, which tend to involve degenerative spinal disease such as herniated lumbar disc or lumbar spinal stenosis. The purpose of this study was to evaluate our experience with incidental durotomies among all pediatric spine patients seen at our institution in order to establish an estimate of the rate of incidental durotomy in the pediatric population. Methods This study was a retrospective chart review examining

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Christina Sayama, Matthew Willsey, Murali Chintagumpala, Alison Brayton, Valentina Briceño, Sheila L. Ryan, Thomas G. Luerssen, Steven W. Hwang, and Andrew Jea

unlimited quantity and immediate availability make rhBMP-2 useful in certain pediatric spine applications, although its cost may be prohibitive in some settings. There are concerns regarding the routine and “off-label” substitution or supplementation of autologous or allograft bone graft with rhBMP-2. Significant concerns involve the possibility of bony overgrowth, interaction with exposed dura, systemic toxicity, local toxicity, immunogenicity, osteoclastic activation, and effects on distal organs; the most serious concern has been the implication of BMP in the

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Ben A. Strickland, Christina Sayama, Valentina Briceño, Sandi K. Lam, Thomas G. Luerssen, and Andrew Jea

L aminar hooks, pedicle screws, and sublaminar wires made of stainless steel, titanium alloys, or cobalt chromium alloys have been used to varying degrees of success as anchors, or fixation points, in the instrumented fusion of the pediatric spine. There are strengths and weaknesses to each of these modalities of fixation to bone. The ideal device should meld the technical ease of sublaminar wires, the adaptability of hooks, and the biomechanical stability of screws, while remaining neurologically safe. Apical sublaminar wires and pedicle screw

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Christina Sayama, Caroline Hadley, Gina N. Monaco, Anish Sen, Alison Brayton, Valentina Briceño, Brandon H. Tran, Sheila L. Ryan, Thomas G. Luerssen, Daniel Fulkerson, and Andrew Jea

unlimited quantity and immediate availability of rhBMP-2 make it useful in certain pediatric spine applications, although its cost may be prohibitive in some circumstances. Previous studies of pediatric occipitocervical and atlantoaxial constructs had reported much higher fusion rates (around 98% to 100%). 7 , 11 , 13 , 16 In recent comparisons of fusion rates following occcipitocervical and atlantoaxial instrumented fusion using a large clinical series and administrative data sets, Mazur et al. 15 and Hankinson et al., respectively, reported higher rates of fusion

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Paul D. Kiely and Matthew E. Cunningham

TO THE EDITOR: We read with interest the article by Lam et al. 7 (Lam SK, Sayama C, Harris DA, et al: Nationwide practice patterns in the use of recombinant human bone morphogenetic protein-2 in pediatric spine surgery as a function of patient-, hospital-, and procedure-related factors. J Neurosurg Pediatr 14:476–485, November 2014). We congratulate them on their study but feel that the use of bone morphogenetic protein (BMP) during pediatric spine surgery needs further clarification. The authors found a significant increase in the use of BMP in

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Andrew Jea

TO THE EDITOR: We made an error in our response to a Letter to the Editor, “Off-label rhBMP-2 use in pediatric spine deformity surgery,” published in the May 2015 issue ( J Neurosurg Pediatr 15 :546, 2015). We stated, “… in a study by Mazur et al., 2 of the 127 pediatric procedures included, 20 (15.7%) resulted in pseudarthrosis and required revision surgery.” This was incorrect. In that study, pseudarthrosis did not occur in 20 cases (15.7%). Rather, what we should have stated was the following: … in a study by Mazur et al., 2 of the 127 pediatric

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Sohum K. Desai, Alison Brayton, Valerie B. Chua, Thomas G. Luerssen, and Andrew Jea

instrumentation with an emphasis on creating more secure fixation and 3D correction. 13 , 14 , 19 , 36 During this period of time, more than 1 million patients benefited from Dr. Harrington's innovative device and procedure. However, Dr. Harrington's impact and influence on pediatric spine surgery continues today. 40 F ig . 1. A picture of Dr. Harrington (left) and his associate Dr. Jesse H. Dickson (right) , now Professor Emeritus, Baylor College of Medicine, circa early 1970s. Dr. Dickson did a wonderful job carrying on and documenting Dr. Harrington's work after

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Spinal instrumentation in infants, children, and adolescents: a review

JNSPG 75th Anniversary Invited Review Article

Stephen Mendenhall, Dillon Mobasser, Katherine Relyea, and Andrew Jea

T he pediatric spine may be affected by various pathologies, which can be categorized as congenital, developmental, and acquired. These etiologies of pediatric spine disease represent an important distinction from those in adults. The inherent properties of the pediatric spine, such as diminutive anatomy, absence of pediatric-specific instrumentation, and inability to extrapolate adult techniques to a child, make the insertion of pediatric instrumentation challenging. A singular problem in the pediatric age group is the restrictive, unwanted effects of spinal