Pediatric Connection
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A PUBLICATION OF THE PEDIATRIC MUSCULOSKELETAL DEPARTMENT OF HOSPITAL FOR SPECIAL SURGERY VOLUME 3 – ISSUE 2 WINTER 2011
MEDICAL STAFF Pediatric Orthopedists John S. Blanco, MD Shevaun M. Doyle, MD Daniel W. Green, MD Cathleen L. Raggio, MD Leon Root, MD David M. Scher, MD Ernest L. Sink, MD Roger F. Widmann, MD Pediatricians H. Susan Cha, MD Lisa S. Ipp, MD Stephanie L. Perlman, MD Pediatric Rheumatologists Alexa B. Adams, MD
Adolescent Idiopathic Scoliosis and Young Athletes: an HSS Update By Roger F. Widmann, MD and Peter Fabricant, MD
Adolescent idiopathic scoliosis (AIS) is a common musculoskeletal disorder. Although it is thought to be genetic, its true cause is unknown and thought to be a combination of many factors. It is characterized by a curvature of the spine measuring greater than 10˚, and has no other symptoms or pain. At 25˚, bracing is recommended in growing adolescents, and if the curve progresses to greater than 50˚, becomes cosmetically unacceptable, or rapidly progresses, surgery may be recommended to correct the deformity and fuse the spine. Although 2% to 3% of the adolescent population is diagnosed with AIS, less than 10% of these patients require any surgical intervention. Because AIS is a painless condition, affected adolescents frequently are athletic and participate
in physical activities alongside their unaffected peers. In the event that surgery is required, one common concern is the ability to return to athletic activity postoperatively. After evaluating a group of 42 patients who underwent curve correction and spinal fusion at HSS over an average of 5.5 years after surgery, (Continued on page 2)
Thomas J.A. Lehman, MD Emma Jane MacDermott, MD
Spondyloarthropathy: “Arthritis of the Back” Pediatric Anesthesiologists Victor M. Zayas, MD Chris R. Edmonds, MD Andrew C. Lee, MD Kathryn (Kate) DelPizzo, MD
Hospital for Special Surgery is an affiliate of NewYork-Presbyterian Healthcare System and Weill Cornell Medical College. For more information about HSS Pediatrics, visit http://www.hss.edu The Pediatric Orthopedic Service provides coverage to the Phyllis & David Komansky Center for Children’s Health at NewYork-Presbyterian Hospital. For more information about the Komansky Center, visit http://www.cornellpediatrics.org
By Alexa B. Adams, MD and Emma Jane MacDermott, MD
One of the more under-recognized forms of juvenile arthritis is spondyloarthropathy. Patients with this condition very often present with recurrent sprains, frequent tendonitis, and low back pain. These children often visit multiple physicians before seeing the rheumatologist, where the pattern of disease involvement is recognized and the diagnosis of spondyloarthropathy is made. Spondyloarthropathy is, by definition, “arthritis of the back,” and describes a pattern of arthritis that commonly involves the spine, sacroiliac joints, and inflammation of the tendons at their insertion around the joints (enthesitis). In adults, low back pain is often the most significant component; however, in children, the disease may present with peripheral joint involvement. Spondyloarthropathy may occur alone or as part of a larger disease process such as celiac disease, inflammatory bowel disease, psoriasis, or Reiter’s disease.
Spondyloarthropathy may occur in association with a genetic marker known as HLA B27. The absence of this marker does not exclude the possibility of a sero-negative spondyloarthropathy. In fact, these patients often have completely normal blood work. In adults with more aggressive symptoms, this association with HLA B27 is linked to a disease entity known as ankylosing spondylitis. (Continued on page 2)