The safety of spinal pedicle screws in children ages 1 to 12

Background contextPedicle screws have shown to be a safe and effective method of spinal fixation, offering superior multiplanar correction compared with hooks or sublaminar wires in selected situations. Though only food and drug administration (FDA) approved in the adolescent population, they are commonly used in an off-label manner in the preadolescent population.PurposeTo determine if the complication rate of the off-label use of pedicle screws for spinal fixation in the preadolescent 0- to 12-year-old population is comparable with the complication rate in the FDA-approved 13- to 18-year-old population.Study design/settingRetrospective medical record and radiograph review.Patient sampleA total of 726 pediatric patients who underwent a spinal fusion procedure at a single tertiary institution between January 2003 and December 2008 were reviewed.Outcome measuresIncidence of instrumentation failure, infection, neurological complication, and total complications.MethodsThe study population was divided into two groups based on age: the younger group included 0- to 12-year olds and the older group included 13- to 18-year olds at the time of surgery. Groups were further subdivided based on diagnosis: “A,” neuromuscular scoliosis; “B,” idiopathic scoliosis, and “C,” other spinal deformities. Rates of neurovascular complications, infections, and instrumentation complications were compared statistically between the younger and the older groups. Only patients with greater than or equal to 1-year follow-up and greater than or equal to 2-year follow-up were included in the calculations for infection and instrumentation complication rates, respectively.ResultsThere were 206 patients (33% males, 67% females) in the younger group (0 to 12 years) and 520 (41% males, 59% females) in the older group (13 to 18 years). Overall, younger group had a 13.6% complication rate compared with 16.9% in the older group. Younger subjects showed a 13.4% complication rate because of instrumentation-related complications, 0.5% for neurovascular complications, and an infection rate of 9.2%. The older group showed a 15.4% complication rate because of instrumentation-related complications, 1.92% for neurovascular complications, and an infection rate of 11.0%. Complication rates were statistically insignificant between the two groups. Other complications in the younger group included one patient with aspiration pneumonia, two with ileus, and one with pulmonary and other complications in the older group included one patient with aspiration pneumonia, two with ileus, three with superior mesenteric artery syndrome, and three with wound dehiscence.ConclusionsThe complication rates in the young pediatric population associated with the off-label use of pedicle screws for spinal fusions are not statistically different from the complication rates associated with the FDA-approved adolescent population.     

Injury Rates in Women Joggers

Injuries were more prevalent early in this conditioning program, but moderately obese women had no more musculoskeletal disorders than leaner women—probably because their training intensity was based on their capacities.     

Semantic loss without surface dyslexia

Abstract

Recent models of reading, including some computational models, suggest that error-free performance in reading aloud may be reliant, at least in part, on support from the semantic system. Such models predict that, following semantic impairment, a pattern of acquired dyslexia known as ‘surface dyslexia’ will be an inevitable consequence. We present data from a patient with dementia of Alzhelmer type who shows a severe semantic impairment but near error-free performance on reading aloud real words (including low-frequency, irregular, abstract words) and non-words. The data are discussed in light of various models of reading and in relation to previously reported cases.     

The Trichotillomania Impact Project in Young Children (TIP-YC): Clinical Characteristics,Comorbidity, Functional Impairment and Treatment Utilization

The aim was to investigate clinical characteristics of young children with a hair pulling problem. Parents/caregivers of young children (0–10 years old) with a hair pulling problem (N = 110) completed an online survey. The majority reported that their child experienced mild to moderate impairment/distress due to hair pulling, and overall clinical characteristics were similar to adult samples, although some differences were noted (e.g., less awareness of pulling). We also compared preschool-aged and school-aged children within the sample. Symptom severity, pleasure during pulling and gender ratio remained stable across the age groups. The preschool-aged children demonstrated less impairment/distress, comorbidity, and treatment seeking; pulled from fewer body areas; and were less likely to be aware of the act or experience tension prior to pulling. In conclusion, clinical characteristics of childhood hair pulling are largely similar to adult/adolescent hair pulling problems, but there are some notable differences, particularly among pre-school aged children.