Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology, 2009
To date, there have been no published studies of the degenerative changes in the cervical spine i... more To date, there have been no published studies of the degenerative changes in the cervical spine in adult idiopathic scoliosis patients with thoracic and lumbar curves severe enough to require major reconstructive surgery. The primary study group was 48 adult patients who had previously undergone a fusion from T10 or higher to the sacrum as an adult for idiopathic scoliosis. These were compared to 38 adults with unfused idiopathic scoliosis of 30 degrees -50 degrees and to 42 symptomatic adults presenting with cervical pain. Cervical degeneration was assessed using a new cervical degenerative index (CDI). The amount of degenerative change seen in the cervical spine in the long-fusion group was significantly higher at baseline (just prior to the fusion) than the two control populations and became much higher at a mean follow-up of 8.5 years. This unique subgroup of patients, those having fusion from the thoracic spine to the sacrum as adults for adolescent idiopathic scoliosis, had a ...
Study Design. Retrospective, controlled clinical study. Objective. To evaluate the contribution o... more Study Design. Retrospective, controlled clinical study. Objective. To evaluate the contribution of an electronic conductivity device (ECD) to the safety of pedicle screw insertion in pediatric scoliosis surgery. Summary of Background Data. The implantation of pedicle screws in spinal deformity correction surgery has evolved into the currently predominant fi xation technique. Methodologies for optimizing placement of pedicle screws are fl uoroscopy, electromyography, and intraoperative image-based navigation. A hand-held ECD was recently introduced. Methods. Pedicle screw insertion was analyzed in 248 pediatric scoliosis patients (idiopathic, congenital, neuromuscular, syndromatic). Group I included 150 procedures without the aid of the ECD and group II included 98 ECD-aided procedures. The two groups were matched by age, sex, etiology, Cobb angle, and surgical criteria. Data on screw position and concomitant neuromonitoring alarms were compared. Group I consisted of patients operated with both the hybrid construct and pedicle screw instrumentation, while group II consisted of patients operated solely with pedicle screws. Both groups were operated on by a single surgeon with the same neurophysiologic methodology. Clinically relevant misplaced pedicle screws were established by intraoperative monitoring alarms concomitant with pedicle screw insertion. Results. A total of 1270 pedicle screw placements were analyzed in group I and compared with 1400 pedicle screw placements in From the
We describe the treatment and follow-up of a case of hereditary multiple exostosis in a 16-year-o... more We describe the treatment and follow-up of a case of hereditary multiple exostosis in a 16-year-old girl, who had intraarticular and extraarticular osteochondromas in the right hip joint which caused hip subluxation. These osteochondromas were excised, the femoral head was located concentrically, and the patient was put in a spica cast for 6 weeks. Six months later, hip magnetic resonance imaging showed no evidence of avascular necrosis. Three years after the operation the patient walked freely, without pain, and there was satisfying coverage of the femoral head. The authors emphasize that careful attention should be given to the surgical technique prior to extraarticular and intraarticular acetabular osteochondroma excision in order to avoid the development of avascular necrosis.
Study Design. A retrospective study of 3 patients with skeletal dysplasia, who had a loss of the ... more Study Design. A retrospective study of 3 patients with skeletal dysplasia, who had a loss of the evoked potentials during prone positioning before spine surgical intervention. Objectives. To bring attention to the potential hazard of neurologic compromise during the positioning of patients with skeletal dysplasia for spine surgery. Recommendations are suggested to prevent the disappearance of intraoperative evoked potentials and, therefore, possible neural injury in these patients. Summary of Background Data. In a very few published cases, loss or attenuation of monitored potentials has been observed at the time of initial patient positioning. Although patients with skeletal dysplasia might be considered particularly vulnerable to spinal cord injury caused by malpositioning of the head and neck, to our knowledge, no association with lost evoked potentials has previously been described. Methods. Intraoperative transcranial electricalr motorevoked potential and/or somatosensory evoked potential baseline studies were performed after induction in the supine position. These studies were repeated as soon as practicable, after intubation and, again, after the patients were turned prone. The neurophysiologist informed the surgeon that evoked potential change in latency or amplitude met warning criteria. Alteration in the surgical plan resulted in successful spinal surgery in these cases. Results. In case No. 1, repositioning of the head in flexion was sufficient to return the evoked potentials to normal. In the other two cases, attempts to reposition the patients prone failed, and the procedures were abandoned. In case No. 2, four months after the initial surgery, a halo cast for immobilization and craniocervical decompression were needed before the corrective cervical spine surgery, and in case No. 3, two steps were taken after the initial surgery: 1) trial positioning awake on the surgical table before surgery; and 2) awake postintubation prone positioning on the actual surgery day. Conclusions. Patients with skeletal dysplasia are susceptible to serious neurologic misadventure when turned to a prone position. Neurophysiologic and/or clinical monitoring of patient positioning should be undertaken, and a plan of intervention, should loss of signal or function occur, must be implemented.
Case report with ultra long-term follow-up. To show the long-term positive benefits of an arthrod... more Case report with ultra long-term follow-up. To show the long-term positive benefits of an arthrodesis at age 3 years. To our knowledge, there have been no previous reports of a 50-year follow-up of a posterior spine fusion for severe congenital kyphosis and segmental spinal dysgenesis. Chart and radiographic documentation of both the preoperative, postoperative, and 50-year follow-up. Solid arthrodesis was achieved after a pseudarthrosis repair. Major correction was achieved and paraplegia prevented. Despite a long fusion to the sacrum, there was no junctional or sacroiliac degeneration. Arthrodesis at age 3 years provided an optimal ultra long-term follow-up.
Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology, 2008
Hereditary multiple exostoses (HME) is a genetic disorder that causes limb deformities due to dis... more Hereditary multiple exostoses (HME) is a genetic disorder that causes limb deformities due to disturbance at the growth plates. Six adolescents, whith symptomatic valgus deformity at the ankle and knee (seven affected legs) underwent correction procedures using the Ilizarov apparatus. In 5 legs, a bifocal Ilizarov apparatus was used, whereas in 2 legs the use of a monofocal apparatus was sufficient. Correction of the mechanical axis was achieved in all cases, and limb length discrepancy was equalized in the 3 cases that underwent limb elogation. The average knee and ankle corrections were 15 degrees and 18 degrees , respectively. The average time from application to removal of the Ilizarove apparatus was 4.6 months. No major complication occurred. The use of the Ilizarov method in adolescents with HME enables successful simultaneous correction of multiplanar, multifocal complex limb deformities.
An anatomic study of 100 patients comparing the pedicle isthmic width of the lower thoracic spine... more An anatomic study of 100 patients comparing the pedicle isthmic width of the lower thoracic spine and the upper lumbar spine using magnetic resonance imaging. To compare the lower thoracic pedicles and upper lumbar pedicles in nondeformity patients as a surrogate measure of safety of pedicle screw use. Pedicle isthmic width is the significant limiting factor in the safety and proper placement of transpedicular screws. The presumption in the past has been that the lumbar pedicles are larger than the thoracic pedicles. Few publications in the English-language literature specifically evaluate the association between the pedicle isthmic widths of the lower thoracic and upper lumbar. The study evaluates 100 patients, without coronal spinal deformities. MRIs were obtained of the pedicles from T10 to L2 and subsequently measured using the axial T2-weighted views. Lower thoracic and upper lumbar pedicle isthmus, the narrowest section of pedicle, was investigated and compared. The "medi...
An extremely rare "transverse fracture&a... more An extremely rare "transverse fracture" of the pelvis is presented. This fracture is not yet classified in currently used classifications of pelvic fractures. A fully detailed description of the fracture is given, along with a possible explanation of the mechanism of the injury.
Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology, 2009
The lack of a widely available scoring system for cervical degenerative spondylosis encouraged th... more The lack of a widely available scoring system for cervical degenerative spondylosis encouraged the authors to establish and validate a systematic quantitative radiographic index. This study included intraobserver and interobserver reliability testing among three reviewers with different years of experience. Each observer independently scored four cervical radiographs of 48 patients at separate intervals, and statistical analysis of the grading was performed. There was high intraobserver and interobserver reliability between the two experienced observers. There was fair reliability between the less experienced observer and the more experienced observers. The cervical degenerative index appears to be a reliable and reproducible radiographic assessment of cervical spondylosis. The index will have direct applicability for longitudinal study of cervical spondylosis and may be clinically relevant as well.
An anatomic study of 100 patients comparing the pedicle isthmic width of the lower thoracic spine... more An anatomic study of 100 patients comparing the pedicle isthmic width of the lower thoracic spine and the upper lumbar spine using magnetic resonance imaging. To compare the lower thoracic pedicles and upper lumbar pedicles in nondeformity patients as a surrogate measure of safety of pedicle screw use. Pedicle isthmic width is the significant limiting factor in the safety and proper placement of transpedicular screws. The presumption in the past has been that the lumbar pedicles are larger than the thoracic pedicles. Few publications in the English-language literature specifically evaluate the association between the pedicle isthmic widths of the lower thoracic and upper lumbar. The study evaluates 100 patients, without coronal spinal deformities. MRIs were obtained of the pedicles from T10 to L2 and subsequently measured using the axial T2-weighted views. Lower thoracic and upper lumbar pedicle isthmus, the narrowest section of pedicle, was investigated and compared. The "medi...
Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology, 2009
To date, there have been no published studies of the degenerative changes in the cervical spine i... more To date, there have been no published studies of the degenerative changes in the cervical spine in adult idiopathic scoliosis patients with thoracic and lumbar curves severe enough to require major reconstructive surgery. The primary study group was 48 adult patients who had previously undergone a fusion from T10 or higher to the sacrum as an adult for idiopathic scoliosis. These were compared to 38 adults with unfused idiopathic scoliosis of 30 degrees -50 degrees and to 42 symptomatic adults presenting with cervical pain. Cervical degeneration was assessed using a new cervical degenerative index (CDI). The amount of degenerative change seen in the cervical spine in the long-fusion group was significantly higher at baseline (just prior to the fusion) than the two control populations and became much higher at a mean follow-up of 8.5 years. This unique subgroup of patients, those having fusion from the thoracic spine to the sacrum as adults for adolescent idiopathic scoliosis, had a ...
Study Design. Retrospective, controlled clinical study. Objective. To evaluate the contribution o... more Study Design. Retrospective, controlled clinical study. Objective. To evaluate the contribution of an electronic conductivity device (ECD) to the safety of pedicle screw insertion in pediatric scoliosis surgery. Summary of Background Data. The implantation of pedicle screws in spinal deformity correction surgery has evolved into the currently predominant fi xation technique. Methodologies for optimizing placement of pedicle screws are fl uoroscopy, electromyography, and intraoperative image-based navigation. A hand-held ECD was recently introduced. Methods. Pedicle screw insertion was analyzed in 248 pediatric scoliosis patients (idiopathic, congenital, neuromuscular, syndromatic). Group I included 150 procedures without the aid of the ECD and group II included 98 ECD-aided procedures. The two groups were matched by age, sex, etiology, Cobb angle, and surgical criteria. Data on screw position and concomitant neuromonitoring alarms were compared. Group I consisted of patients operated with both the hybrid construct and pedicle screw instrumentation, while group II consisted of patients operated solely with pedicle screws. Both groups were operated on by a single surgeon with the same neurophysiologic methodology. Clinically relevant misplaced pedicle screws were established by intraoperative monitoring alarms concomitant with pedicle screw insertion. Results. A total of 1270 pedicle screw placements were analyzed in group I and compared with 1400 pedicle screw placements in From the
We describe the treatment and follow-up of a case of hereditary multiple exostosis in a 16-year-o... more We describe the treatment and follow-up of a case of hereditary multiple exostosis in a 16-year-old girl, who had intraarticular and extraarticular osteochondromas in the right hip joint which caused hip subluxation. These osteochondromas were excised, the femoral head was located concentrically, and the patient was put in a spica cast for 6 weeks. Six months later, hip magnetic resonance imaging showed no evidence of avascular necrosis. Three years after the operation the patient walked freely, without pain, and there was satisfying coverage of the femoral head. The authors emphasize that careful attention should be given to the surgical technique prior to extraarticular and intraarticular acetabular osteochondroma excision in order to avoid the development of avascular necrosis.
Study Design. A retrospective study of 3 patients with skeletal dysplasia, who had a loss of the ... more Study Design. A retrospective study of 3 patients with skeletal dysplasia, who had a loss of the evoked potentials during prone positioning before spine surgical intervention. Objectives. To bring attention to the potential hazard of neurologic compromise during the positioning of patients with skeletal dysplasia for spine surgery. Recommendations are suggested to prevent the disappearance of intraoperative evoked potentials and, therefore, possible neural injury in these patients. Summary of Background Data. In a very few published cases, loss or attenuation of monitored potentials has been observed at the time of initial patient positioning. Although patients with skeletal dysplasia might be considered particularly vulnerable to spinal cord injury caused by malpositioning of the head and neck, to our knowledge, no association with lost evoked potentials has previously been described. Methods. Intraoperative transcranial electricalr motorevoked potential and/or somatosensory evoked potential baseline studies were performed after induction in the supine position. These studies were repeated as soon as practicable, after intubation and, again, after the patients were turned prone. The neurophysiologist informed the surgeon that evoked potential change in latency or amplitude met warning criteria. Alteration in the surgical plan resulted in successful spinal surgery in these cases. Results. In case No. 1, repositioning of the head in flexion was sufficient to return the evoked potentials to normal. In the other two cases, attempts to reposition the patients prone failed, and the procedures were abandoned. In case No. 2, four months after the initial surgery, a halo cast for immobilization and craniocervical decompression were needed before the corrective cervical spine surgery, and in case No. 3, two steps were taken after the initial surgery: 1) trial positioning awake on the surgical table before surgery; and 2) awake postintubation prone positioning on the actual surgery day. Conclusions. Patients with skeletal dysplasia are susceptible to serious neurologic misadventure when turned to a prone position. Neurophysiologic and/or clinical monitoring of patient positioning should be undertaken, and a plan of intervention, should loss of signal or function occur, must be implemented.
Case report with ultra long-term follow-up. To show the long-term positive benefits of an arthrod... more Case report with ultra long-term follow-up. To show the long-term positive benefits of an arthrodesis at age 3 years. To our knowledge, there have been no previous reports of a 50-year follow-up of a posterior spine fusion for severe congenital kyphosis and segmental spinal dysgenesis. Chart and radiographic documentation of both the preoperative, postoperative, and 50-year follow-up. Solid arthrodesis was achieved after a pseudarthrosis repair. Major correction was achieved and paraplegia prevented. Despite a long fusion to the sacrum, there was no junctional or sacroiliac degeneration. Arthrodesis at age 3 years provided an optimal ultra long-term follow-up.
Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology, 2008
Hereditary multiple exostoses (HME) is a genetic disorder that causes limb deformities due to dis... more Hereditary multiple exostoses (HME) is a genetic disorder that causes limb deformities due to disturbance at the growth plates. Six adolescents, whith symptomatic valgus deformity at the ankle and knee (seven affected legs) underwent correction procedures using the Ilizarov apparatus. In 5 legs, a bifocal Ilizarov apparatus was used, whereas in 2 legs the use of a monofocal apparatus was sufficient. Correction of the mechanical axis was achieved in all cases, and limb length discrepancy was equalized in the 3 cases that underwent limb elogation. The average knee and ankle corrections were 15 degrees and 18 degrees , respectively. The average time from application to removal of the Ilizarove apparatus was 4.6 months. No major complication occurred. The use of the Ilizarov method in adolescents with HME enables successful simultaneous correction of multiplanar, multifocal complex limb deformities.
An anatomic study of 100 patients comparing the pedicle isthmic width of the lower thoracic spine... more An anatomic study of 100 patients comparing the pedicle isthmic width of the lower thoracic spine and the upper lumbar spine using magnetic resonance imaging. To compare the lower thoracic pedicles and upper lumbar pedicles in nondeformity patients as a surrogate measure of safety of pedicle screw use. Pedicle isthmic width is the significant limiting factor in the safety and proper placement of transpedicular screws. The presumption in the past has been that the lumbar pedicles are larger than the thoracic pedicles. Few publications in the English-language literature specifically evaluate the association between the pedicle isthmic widths of the lower thoracic and upper lumbar. The study evaluates 100 patients, without coronal spinal deformities. MRIs were obtained of the pedicles from T10 to L2 and subsequently measured using the axial T2-weighted views. Lower thoracic and upper lumbar pedicle isthmus, the narrowest section of pedicle, was investigated and compared. The "medi...
An extremely rare "transverse fracture&a... more An extremely rare "transverse fracture" of the pelvis is presented. This fracture is not yet classified in currently used classifications of pelvic fractures. A fully detailed description of the fracture is given, along with a possible explanation of the mechanism of the injury.
Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology, 2009
The lack of a widely available scoring system for cervical degenerative spondylosis encouraged th... more The lack of a widely available scoring system for cervical degenerative spondylosis encouraged the authors to establish and validate a systematic quantitative radiographic index. This study included intraobserver and interobserver reliability testing among three reviewers with different years of experience. Each observer independently scored four cervical radiographs of 48 patients at separate intervals, and statistical analysis of the grading was performed. There was high intraobserver and interobserver reliability between the two experienced observers. There was fair reliability between the less experienced observer and the more experienced observers. The cervical degenerative index appears to be a reliable and reproducible radiographic assessment of cervical spondylosis. The index will have direct applicability for longitudinal study of cervical spondylosis and may be clinically relevant as well.
An anatomic study of 100 patients comparing the pedicle isthmic width of the lower thoracic spine... more An anatomic study of 100 patients comparing the pedicle isthmic width of the lower thoracic spine and the upper lumbar spine using magnetic resonance imaging. To compare the lower thoracic pedicles and upper lumbar pedicles in nondeformity patients as a surrogate measure of safety of pedicle screw use. Pedicle isthmic width is the significant limiting factor in the safety and proper placement of transpedicular screws. The presumption in the past has been that the lumbar pedicles are larger than the thoracic pedicles. Few publications in the English-language literature specifically evaluate the association between the pedicle isthmic widths of the lower thoracic and upper lumbar. The study evaluates 100 patients, without coronal spinal deformities. MRIs were obtained of the pedicles from T10 to L2 and subsequently measured using the axial T2-weighted views. Lower thoracic and upper lumbar pedicle isthmus, the narrowest section of pedicle, was investigated and compared. The "medi...
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Papers by Elisha Ofiram