STUDY DESIGN.: A retrospective, consecutive case study of 1571 pediatric patients who underwent spinal deformity surgery and had minimum 2-year follow-up. OBJECTIVE.: To identify (1) the rate of infection after pediatric spinal deformity surgery; (2) the number of surgeries required to treat a postoperative infection after a pediatric spinal deformity surgery; (3) the percentage of patients with a postoperative infection after pediatric spinal deformity surgery who require implant removal to quantify the effect of removal on the deformity; and (4) the microbiology of postoperative infections after pediatric spinal deformity surgery. SUMMARY OF BACKGROUND DATA.: Several previous reports have discussed the rates of infection after spinal surgery for pediatric spinal deformity. No previous reports have quantified the rate and magnitude of deformity progression after infection in pediatric spinal deformity surgery. METHODS.: A retrospective review was performed of the medical records and radiographs of all children undergoing surgery for spinal deformity at the Shriners Hospital for Children in Chicago from January 1, 1975, to June 1, 2005. RESULTS.: The rate of infection varied based on underlying diagnosis: idiopathic scoliosis 0.5%, myelomeningocele 19.2%, myopathies 4.3%, and cerebral palsy 11.2%. On average, 2 surgeries were required to eradicate the infection. Approximately half of the patients required removal of the instrumentation to treat their infection. Forty-four percent of patients who developed an infection had significant progression of their deformity, with an average increase in deformity magnitude of 27 degrees . Implant removal predisposed patients to progression of deformity. The 3 most common organisms in order were Staphylococcus aureus, S. epidermidis, and Pseudomonas aeruginosa. CONCLUSION.: Infection after spinal deformity in idiopathic scoliosis is rare but is relatively common in neuromuscular conditions. Eradication of infection can be expected, but implant removal is often required. Should implants be totally removed, significant progression of the deformity is possible.

OBJECTIVE: To measure the effect of intensive therapy and the lasting effect of a standardized functional training programme with vs. without the addition of chemodernervation of the muscles of the forearm and hand. PATIENTS AND METHODS: Twenty children with spastic hemiplegia, aged 4-16 years, were matched for baseline characteristics and randomized to standardized task-oriented therapy for 6 months with or without botulinum toxin injections. Dynamic kinematic outcome measures were: speed, accuracy, end-point spread and performance. Measurements of active and passive range of motion, stretch-restricted angle of the elbow and wrist, Ashworth scores and Melbourne Assessment of Unilateral Upper Limb Function were made. All measures were performed at baseline, 2 weeks after injection of botulinum toxin and after 6 months (at the end of therapy), and 3 months after end of the therapy. RESULTS: Clinical measures showed improvement in both groups. However, no significant differences emerged between groups on functional measures. Directly after the botulinum toxin injection all kinematic outcome measures showed a decrease, but baseline values were re-established during the therapy period. After botulinum toxin injections a temporarily significant greater increase in speed and performance was found. These results illustrate the need for further quantitative research into the effects of botulinum toxin.

OBJECTIVE: To evaluate the association between umbilical cord pH at birth and long term outcomes. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Medline (1966-August 2008), Embase (1980-August 2008), the Cochrane Library (2008 issue 8), and Medion, without language restrictions; reference lists of selected articles; and contact with authors. STUDY SELECTION: Studies in which cord pH at birth was compared with any neonatal or long term outcome. Cohort and case-control designs were included. RESULTS: 51 articles totalling 481 753 infants met the selection criteria. Studies varied in design, quality, outcome definition, and results. Meta-analysis carried out within predefined groups showed that low arterial cord pH was significantly associated with neonatal mortality (odds ratio 16.9, 95% confidence interval 9.7 to 29.5, I(2)=0%), hypoxic ischaemic encephalopathy (13.8, 6.6 to 28.9, I(2)=0%), intraventricular haemorrhage or periventricular leucomalacia (2.9, 2.1 to 4.1, I(2)=0%), and cerebral palsy (2.3, 1.3 to 4.2, I(2)=0%). CONCLUSIONS: Low arterial cord pH showed strong, consistent, and temporal associations with clinically important neonatal outcomes that are biologically plausible. These data can be used to inform clinical management and justify the use of arterial cord pH as an important outcome measure alongside neonatal morbidity and mortality in obstetric trials.

Aim To determine whether there is a difference between perspectives of functioning and health-related quality of life (HRQL) of parents and ambulatory adolescents with spastic cerebral palsy (CP). Method A total of 139 parent patient pairs (73 females, 66 males; median age 14y 6mo, age range 11-18y, Gross Motor Function Classification System [GMFCS] levels I-III, with hemiplegia [n=23], diplegia [n=103], triplegia [n=9], and quadriplegia [n=4]) were recruited from outpatient CP clinics at three pediatric orthopaedic hospitals, between 2000 and 2006, from whom Pediatric Outcomes Data Collection Instrument (PODCI) responses were collected. Results Cross-sectional data, calculated with intraclass correlation coefficients [ICC], showed parents and adolescents agreed more on functioning (ICC=0.488-0.748) than HRQL (ICC=0.242-0.568; PODCI). Parents and adolescents both recognized significant comorbidities (ICC=0.502-0.713), but adolescents saw themselves as less limited (ICC=0.330) than parents. The greatest differences between parents and adolescents were in HRQL scales for male adolescents, with only a small part explained by GMFCS level difference between sexes (effect size 0.002-0.143). Age, parent well-being, and parent sex had little effect and comorbidities had no effect. GMFCS level was the most common predictor. Interpretation Most scales on health conditions, function, and HRQL agreed between parents and adolescents aged11 to 18 years. Parent proxy is reasonable when necessary, but assessing both parents and adolescents gives additional insight. Adolescents do not consider themselves as limited by health conditions as parents do; parents have greater satisfaction with current level of symptoms than adolescents, and findings vary on expectations for treatment.

INTRODUCTION: There are publications in which various neurological diseases are analysed on film. However, no references have been found on movement disorders in this medium. Methodology and results: A total of 104 documents were collected and reviewed using the internet movie data base (IMDb). The majority were associated with dystonia, Parkinson’s and tics, were American commercial productions, and the most common genre was drama. DISCUSSION: The cinema usually depicts old men with developed Parkinson’s disease. However, motor complications only appear in 19% and non-motor symptoms in 14%. The image of dystonia is generally that of a young man, with disabling dystonia secondary to childhood cerebral palsy. Tics appear associated with Tourette’s syndrome, with the excessive use of obscene expressions and with very few references to other important aspects of this syndrome, such as mood and behavioural changes. The majority of tremors portrayed on film are associated with Parkinsonism and are not pathological. Myoclonus appears anecdotically and is normally symptomatic. CONCLUSIONS: Parkinson’s disease is the type of movement disorder that the cinema portrays with greater neurological honesty and in a more dignified manner.