Neck of femur and Distal end radius fracture case... evidence based #dr_azankiAbdallah El-Azanki
a 46 years old patient with ipsilateral neck femur and distal end radius fracture, the aim of this lecture is to highlight the deficit of evidence base or literature for such combined cases and to stimulate orthopedic surgeons in reporting how did they manage their cases.
#dr_azanki
Guided Growth for Angular Knee Deformities in Nutritional Rickets ChildrenTamer El-Sobky
Nutritional rickets in children is a global health concern. It manifests in generalized skeletal deformities including angular or coronal plane knee deformities. Guided growth surgery is a recognized treatment option for angular knee deformities in general. However, there is insufficient citations on its use in the treatment of angular knee deformities in children with nutritional rickets. Rachitic lower limb deformities can be complex. They are usually multiostotic, multiapex and multiplane and require extensive corrective osteotomies. However osteotomies are fraught with complications and can be technically demanding. In this presentation we present our experience with the use of surgical guided growth as a minimally invasive treatment option to correct angular knee deformities in children with nutritional rickets.
Journal club presentation on Shoulder Arthroplasty for Fractures of the Proximal part of the Humerus. Based on review article published in Journal of Bone & Joint Surgery (America)
Indications, Surgical techniques, outcomes are discussed in detail.
Neck of femur and Distal end radius fracture case... evidence based #dr_azankiAbdallah El-Azanki
a 46 years old patient with ipsilateral neck femur and distal end radius fracture, the aim of this lecture is to highlight the deficit of evidence base or literature for such combined cases and to stimulate orthopedic surgeons in reporting how did they manage their cases.
#dr_azanki
Guided Growth for Angular Knee Deformities in Nutritional Rickets ChildrenTamer El-Sobky
Nutritional rickets in children is a global health concern. It manifests in generalized skeletal deformities including angular or coronal plane knee deformities. Guided growth surgery is a recognized treatment option for angular knee deformities in general. However, there is insufficient citations on its use in the treatment of angular knee deformities in children with nutritional rickets. Rachitic lower limb deformities can be complex. They are usually multiostotic, multiapex and multiplane and require extensive corrective osteotomies. However osteotomies are fraught with complications and can be technically demanding. In this presentation we present our experience with the use of surgical guided growth as a minimally invasive treatment option to correct angular knee deformities in children with nutritional rickets.
Journal club presentation on Shoulder Arthroplasty for Fractures of the Proximal part of the Humerus. Based on review article published in Journal of Bone & Joint Surgery (America)
Indications, Surgical techniques, outcomes are discussed in detail.
I delivered this talk to a group of hand and arm therapists. Find out more about hand and arm problems at http://www.noelhenley.com
Ozark Orthopaedic: Henley C Noel MD
3317 North Wimberly Drive, Fayetteville, AR 72703
(479) 521-2752
The hip joint is a ball and socket joint consisting of the femoral head and acetabulum. This articulation provides multiple planes of movement and is highly congruent. Articular cartilage, consisting of type II collagen, covers the majority of the femoral head. The acetabulum peripherally consists of articular cartilage while the central floor is non-articular and filled with a fatty layer termed the pulvinar. The ligamentum teres arises from both the transverse acetabular ligament and the central non-articular layer of the acetabulum and attaches to the central femoral head. It may play a role in stabilizing the hip joint.
Similar to hints about spine instrumentation and deformity correction (20)
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
3. IOLS
-History of scoliosis management
-Surgeries for scoliosis deformity
-Options for spine instrumentations
-history of pedicle screws
-Principle for pedicle screws
-Advantages of pedicle screws
-Complications of pedicle screws
4. Spine deformity is a big dilemma dating many decades before
-Among pharaohs of the 18th and 19th dynasty 3 kings
had spine deformity.
-Amenhotep (Amenophis) II,
-Ramses II (The Great), and
-Merenptah ( his son ).
Imhotep is the first
known surgeon
5.
6.
7. -In the ancient world medicine
was not distinguished from
religion and mysticism
-Ancient works of philosophy,
religion, myths, and fairy tales
dating back as far as
3500 BC invoke images of
people with spinal deformity.
The boxing boys
fresco … Room
1600 BC
8. -Greeks also reported
deformity in statues
and described it in
scientific bases
-Hippocrates describes the
normal curves of the
spine in details
Alexander the
great with neck
deformity
10. -He classified the vertebrae into three groups.
1-the vertebrae lying above the clavicle
2-the thoracic vertebrae
3-the 5 vertebrae between the chest and the pelvis.
-Hippocrates introduced the terms kyphosis and
scoliosis and wrote in depth about diagnosis and
treatment of both.
11. -kyphosis → when the spine moves backward.
-lordosis → when it moves forward.
-Scoliosis → when it moves to the side.
-Succussion → when there is no deformity but the
vertebrae had slipped.
Galen described 4 deformities
13. According to Hippocrates and Galen deformity is
caused by
-Tuberculous nodes in the lung
-Trauma due to a fall on hips or shoulders,
-aging
-painful conditions
14. -Hippocrates recommended diet and extension of the
spine for the treatment of scoliosis.
-Manipulation was widely practiced by Hippocrates.
-He invented devices based on
-Extension.
-Axial traction.
-Three points compression.
19. -Ancient Arabian doctors had also
their contribution in the field of
spine deformity
-Famous example is the work of
Avicenna (980-1037)
However most of his work
was lost or stolen
Avicenna (Ibn-Cina)
20.
21. -First true surgery was done by Guerin in 1839
-Percutaneous myotomies of the praspinal muscle
on the concave side
-Followed by long periods of immobilization
-Some success was obtained
-In 1891, Hadra attempted wiring of the spinous
processes in a patient with kyphosis due to Pott’s
disease .
22. -In 1911 Hibbs advocated non instrumented fusion for
a deformed spine.
-This procedure initially provided Stabilization but
-relied on the use of casts for long time
-did not provide deformity correction.
-Trials for instrumentations appeared at the beginning
of 1900 after discovery of antibiotics.
23. -Fritz Lange in the early 1900s, was one of the first
physicians to use foreign materials such as silk or
metal to support the spine
-He used steel splint in the spine
-4mm steel wires on each side of the spinous P,
-Inserted under the muscles and
-Fixed by silver wires .
-Caused infection and irritation by its sharp edges.
24. -In 1908, he used a tin coated wire
-5mm thick and 10 cm long
-Knobs on either end to reduce irritation
-Fixed to the spinous processes using silk.
-Patient kept in plaster jacket for 6 weeks then slowly
mobilized.
-He concluded that instrumentation lead to rapid
fusion than non-instrumentation.
25. -The goal of surgery at this time was halting the
progression of deformity
-Harrington system, since 1962 remained the state of
the art technique for scoliosis correction for a decade
and a half.
-It was primarily designed to apply distraction to the
spine.
-50-60% of curve correction could be achieved using
these rods and the results considered excellent.
26.
27. -This system marked the beginning of the great era of
scoliosis surgery .
the major pitfalls of the system:
1. Limited amount of correction
2. Iatrogenic flatback
3. Does not address rotational deformity
4. Lamina fracture if excessive forces are applied
5. Inadequate rib cage correction
6. Post operative immobilization required
28. -In 1973, Edwardo Luque introduced the principle of
segmental fixation.
-This procedure involved multiple points of fixation by
sublaminar wires to create a more rigid option
-The goal was to reduce the need for external
immobilization.
-it involved steel sublaminar wires at various levels
over prebent rods .
-This technique improved sagittal balance, but many
neurological complications was noticed
29. -Hybrid system was done and called (tex-mix)
-The great break-through in deformity surgery was
the appearance of pedicle screws
-Another advancement was the development of
crosslinking devices that provide additional stability
-The TSRH system was the first to utilize cross-links
(Texas Scottish Right Hospital, 1983).
31. History
-Boucher and king in1943 had found that it is
applicable to use facet screws to immobilize spine till
the graft is taken
-Later on Boucher described the first principles of
pedicle screws in spine
-The actual era of the pedicle screw began when Roy-
Camille (1970) reported the use of a screw-plate
device for spinal fractures.
32. -The development of rod-screw systems made
contouring easier, and encouraged the use of pedicle
screws in the treatment of scoliosis.
-After these advances pedicle screw instrumentations
became the ‘state-of-the-art’ for spinal disorders
including deformity
-In 1995 pedicle screws have been FDA approved for
spondylolisthesis only.
33. Advantages of pedicle screws
-Offers an enhanced three-dimensional deformity
correction
-Preserve motion segments by reducing the number
of fused levels
-They can rigidly stabilize both the ventral and dorsal
aspects of the spine.
-Can be used after laminectomy or spinal osteotomy
-Unlike sublaminar wires do not violate the vertebral
canal.
34. -Increase fusion rate markedly with less incidence of
psudoarthrosis
-Provide the strongest point of attachment of the
vertebra, and allows forces to be applied to the spine
without failure of the bone metal interface.
35. -Every screw has a head, shaft, and threaded portion
-The minor diameter of the screw is that of its core
-The major diameter of the screw is the threaded part
-Mechanical bending force is a function of the
core diameters
-Change in core diameter significantly changes the
bending strength of screws
-Two fold increase in core diameter causes eight
folds increase in bending strength
36. The pullout strength of screws depend on
-Screw bone interface
-Quality of bone
-Screw length
-Outer diameter of the screw
37. insertion technique
Since the introduction of original insertion technique
by Suk many other technique were published
-Funneling
-Mini laminotomy
-C-arm guided……etc
-the spine is exposed traditionally with subperiosteal
dissection
38. -The entry point for the targeted pedicle is identified
-Entry point is decorticate by a burr or rongeure
-Some surgeons prefer to do facetectomy before
pedicle screw insertion
-The pedicle finder is used to determine the proper
direction of the pedicle
-At the UIV and LIV no extreme medial or lateral
trajectory is needed however in the apex extreme
lateral or medial direction is needed
39. -Marker may be used and proper position is ensured
by c-arm
-Screw dimeter is ideal to be 80% of the pedicle width
-The pedicle may tolerate a screw size 115% of pedicle
size
-As regard screw length the pedicle alone provides 60-
80% of the screw purchase and the body provide the
remaining 40-20%
40. -The ideal screw length should penetrate 70% of the
vertebral body
-The screws should never exceed 5mm of the anterior
vertebral wall
-Extra pedicular approach may be utilized in difficult
insertion or in hypoplastic pedicles
- Extra pedicular screws may be used on the concavity
41. -Pedicle screws in the thoracic spine were not widely
used because of the fear of neurological injury
-despite the superior biomechanical advantages of
pedicle screws over other forms of spinal
instrumentation it maybe hazardous.
-The incidence of misplaced thoracic pedicle screws
ranges from 1.5-25%.
-The incidence of screw-related neurological
complication is 0.9%.
42. Complications of pedicle screws
-Loss of curve correction.
at the end of follow-up this ranges from (1 - 5.4)%.
-Screw malposition
This varies from (1.2 – 20)%.
-Dural Lesion
durotomy is about 0.35% per screw all was on the
concavity of the dorsal curve.
45. -Vascular complications
Although injury to the IVC, Aorta, Azygos v and iliac
vessels were reported special concern was given for
the aorta in most literatures
-Highest risk of injuring the aorta at T10, T4, T11, and
T9 in right thoracic idiopathic scoliosis.
-Preoperative evaluation of the position of the aorta
to the thoracic spine significantly important for safe
pedicle screw placement.
47. Pedicle Screws In EOS
Pedicle screws in EOS has a special concern as regard
-Small size of the pedicle
-Change in the canal morphology
-Pedicle screws are more superior than hooks or
sublaminar wires as regard stability and ability
to withstand distraction force
48. however to be inserted in the body it needs to pass
the NCC which is an active growth plate that fuse at
the age of 4-7 years
In his study on procine model Yazici found that
unilateral pedicle screws significantly alter
pedicle/hemi-canal growth compared to controls
with no instrumentation
49. -Ruf and Harms showed that pedicle screw could be
used in 2 years-old child without negative effects on
vertebral growth
-El-Sharkawi and Alkot in a study on 21 patient with
EOS found no evidence of canal stenosis at the
pedicle screws level level
-Most author accept this principle and pedicle screws
are used widely for EOS patient as proximal or distal
foundation points
50. Take home message
Pedicle screws are safe, effective, anchoring points for
spine deformity surgery in older or very young
patients