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Search Results: 1 - 10 of 198478 matches for " Hitesh N Modi "
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Correlation and comparison of Risser sign versus bone age determination (TW3) between children with and without scoliosis in Korean population
Hitesh N Modi, Chetna H Modi, Seung Suh, Jae-Hyuk Yang, Jae-Young Hong
Journal of Orthopaedic Surgery and Research , 2009, DOI: 10.1186/1749-799x-4-36
Abstract: To analyze and compare the skeletal age with the Risser sign between scoliosis and non-scoliosis group, a cross-sectional study was done in 418 scoliosis (untreated, bracing or surgically) and 256 non-scoliosis children of Korean origin. Relationship was found in both groups using Pearson correlation test.In scoliosis group, Pearson correlation exhibited significant correlation (p < 0.01) between Risser sign and chronological age (r2 = 0.791 for girls, 0.787 for boys) and Risser sign and TW3 age (r2 = 0.718 for girls, 0.785 for boys). Non-scoliosis group also showed significant relationship (p < 0.01) between Risser sign and chronological age (r2 = 0.893 for girls, 0.879 for boys) and Risser sign and TW3 age (r2 = 0.913 for girls, 0.895 for boys). Similarly, comparing Cobb angles of each patient according to their Risser staging, exhibited that if scoliosis remains untreated Cobb angle will increase with the increase in their Risser staging (r2 = 0.363 for girls, 0.443 for boys; p < 0.01).Our results showed that chronological age is equally as reliable as skeletal age method to compare with Risser sign, and therefore, we do not mean to imply that only the Risser sign compared with skeletal age should be considered in the decision making in idiopathic as well as non-scoliosis patients of Korean ethnicity. Concomitant indicators such as menarchal period, secondary sex characteristics, and recent growth pattern will likely reinforce our data comparing Risser sign with skeletal age in decision making.Prognostic studies related to the risk of curve progression in patients with idiopathic scoliosis (IS) have been hampered by poor measurements of skeletal maturity and arbitrary definitions of curve progression. Literature [1] described a number of potential skeletal maturity indicators, including Risser sign, the Oxford stage, The Greulich and Pyle (GP) and Tanner-Whitehouse-III (TW3) maturity assessments, and a number of serological skeletal maturity markers in girls with
Differential wedging of vertebral body and intervertebral disc in thoracic and lumbar spine in adolescent idiopathic scoliosis – A cross sectional study in 150 patients
Hitesh N Modi, Seung Suh, Hae-Ryong Song, Jae-Hyuk Yang, Hak-Jun Kim, Chetna H Modi
Scoliosis , 2008, DOI: 10.1186/1748-7161-3-11
Abstract: This cross sectional study in 150 patients of adolescent idiopathic scoliosis was done to evaluate vertebral body and disc wedging in scoliosis and to compare the extent of differential wedging of body and disc, in thoracic and lumbar area. We measured wedging of vertebral bodies and discs, along with two adjacent vertebrae and disc, above and below the apex and evaluated them according to severity of curve (curve < 30° and curve > 30°) to find the relationship of vertebral body or disc wedging with scoliosis in thoracic and lumbar spine. We also compared the wedging and rotations of vertebrae.In both thoracic and lumbar curves, we found that greater the degree of scoliosis, greater the wedging in both disc and body and the degree of wedging was more at apex supporting the theory of growth retardation in stress concentration area. However, the degree of wedging in vertebral body is more than the disc in thoracic spine while the wedging was more in disc than body in lumbar spine. On comparing the wedging with the rotation, we did not find any significant relationship suggesting that it has no relation with rotation.From our study, we can conclude that wedging in disc and body are increasing with progression on scoliosis and maximum at apex; however there is differential wedging of body and disc, in thoracic and lumbar area, that is vertebral body wedging is more profound in thoracic area while disc wedging is more profound in lumbar area which possibly form 'vicious cycle' by asymmetric loading to spine for the progression of curve.Scoliosis is a three-dimensional deformity involving coronal, sagittal and axial angulations. Extent of the disease progress, decision to change the treatment strategy and efficacy of the treatment are mainly dependent on the severity in coronal plane angle, commonly known as Cobb's angle as a primary interest. In idiopathic scoliosis, factors responsible for the progression of curve are still unclear and authors have their own point of vi
Spontaneous regression of curve in immature idiopathic scoliosis - does spinal column play a role to balance? An observation with literature review
Hitesh N Modi, Seung-Woo Suh, Jae-Hyuk Yang, Jae-Young Hong, KP Venkatesh, Nasir Muzaffar
Journal of Orthopaedic Surgery and Research , 2010, DOI: 10.1186/1749-799x-5-80
Abstract: An observational study of serial radiograms in 169 idiopathic scoliosis children (with minimum follow-up one year) was carried. All children with Cobb angle < 25° and who were diagnosed for the first time were selected. As a sign of immaturity at the time of diagnosis, all children had Risser sign 0. No treatment was given to entire study group. Children were divided in three groups at final follow-up: Group A, B and C as children with regression, no change and progression of their curves, respectively. Additionally changes in the pattern of curve were also noted.Average age was 9.2 years at first visit and 10.11 years at final follow-up with an average follow-up of 21 months. 32.5% (55/169), 41.4% (70/169) and 26% (44/169) children exhibited regression, no change and progression in their curves, respectively. 46.1% of children (78/169) showed changing pattern of their curves during the follow-up visits before it settled down to final curve. Comparing final fate of curve with side of curve and number of curves it did not show any relationship (p > 0.05) in our study population.Possible reason for changing patterns could be better explained by the tuning/balancing mechanism of spinal column that makes an effort to balance the spine and result into spontaneous regression or prevent further progression of curve. If this which we called as "tuning/balancing mechanism" fails, curve will ultimately progress.A major concern of orthopaedic surgeons in managing children with idiopathic scoliosis with a minor curvature is identifying how many and which curve will progress to severe deformities that requires treatment [1-9]. Accurate identification of curves destined to progress requires a clear understanding of the natural history of idiopathic scoliosis. A curve measuring greater than 10°, using the Cobb method, was defined as a structural scoliosis according to the Scoliosis Research Society criteria [10].Soucacos et al reported 27.4% spontaneous improvement of at least 5°
Two levels above and one level below pedicle screw fixation for the treatment of unstable thoracolumbar fracture with partial or intact neurology
Hitesh N Modi, Kook Chung, Il Seo, Hoi Yoon, Ji Hwang, Hong Kim, Kyu Noh, Jung Yoo
Journal of Orthopaedic Surgery and Research , 2009, DOI: 10.1186/1749-799x-4-28
Abstract: We retrospectively analyzed 31 unstable thoracolumbar fractures with partial or intact neurology. All patients were operated with posterior approach using pedicle screws fixed two levels above and one level below the fracture vertebra. No laminectomy, discectomy or decompression procedure was done. Posterior fusion was achieved in all. Post operative and at final follow-up radiological evaluation was done by measuring the correction and maintenance of kyphotic angle at thoracolumbar junction. Complications were also reported including implant failure.Average follow-up was 34 months. All patients had full recovery at final follow-up. Average kyphosis was improved from 26.7° to 4.1° postoperatively and to 6.3° at final follow-up. And mean pain scale was improved from 7.5 to 3.9 postoperatively and to 1.6 at final follow-up, All patients resumed their activity within six months. Only 4 (12%) complications were noted including only one hardware failure.Two levels above and one level below pedicle screw fixation in unstable thoracolumbar burst fracture is useful to prevent progressive kyphosis and preserves one motion segment distally.The thoracolumbar junction is the most common site of spinal injuries. The surgical treatment of unstable fractures and fracture dislocations of thoracolumbar spine remains controversial [1]. The goals of treatment in thoracolumbar fractures are restoring vertebral column stability and obtaining spinal canal decompression, leading to early mobilization of the patient. Either anterior, posterior or both approaches can be used to achieve fusion but the efficacy of either approach is the same [2,3]. However, posterior approach is less extensive, and most spine surgeons advocate posterior fusion as the treatment of choice for unstable thoracolumbar injuries [4,5]. The importance of early decompression and stabilization of unstable vertebral injuries has been emphasized in several reports [4,6]. Pedicle screw devices allow immediate stable fixat
Treatment of neuromuscular scoliosis with posterior-only pedicle screw fixation
Hitesh N Modi, Seung-Woo Suh, Hae-Ryong Song, Harry M Fernandez, Jae-Hyuk Yang
Journal of Orthopaedic Surgery and Research , 2008, DOI: 10.1186/1749-799x-3-23
Abstract: Between 2003 and 2006, 26 consecutive patients (7 cerebral palsy, 10 Duchenne muscular dystrophy, 5 spinal muscular atrophy and 4 others) with neuromuscular scoliosis underwent posterior pedicle screw fixation for the deformity. Preoperative, immediate postoperative and final follow-up Cobb's angle and pelvic obliquity were analyzed on radiographs. The average age of the patients was 17.5 years (range, 8–44 years) and the average follow-up was 25 months (18–52 months).Average Cobb's angle was 78.53° before surgery, 30.70° after surgery (60.9% correction), and 33.06° at final follow-up (57.9% correction) showing significant correction (p < 0.0001). There were 9 patients with curves more than 90° showed an average pre-operative, post operative and final follow up Cobb's angle 105.67°, 52.33° (50.47% correction) and 53.33° (49.53% correction) respectively and 17 patients with curve less than 90° showed average per operative, post operative and final follow up Cobb's angle 64.18, 19.24(70% correction) and 21.41(66.64 correction); which suggests statistically no significant difference in both groups (p = 0.1284). 7 patients underwent Posterior vertebral column resection due to the presence of a rigid curve. The average spinal-pelvic obliquity was 16.27° before surgery, 8.96° after surgery, and 9.27° at final follow-up exhibited significant correction (p < 0.0001). There was 1 poliomyelitis patient who had power grade 3 in lower limbs pre-operatively, developed grade 2 power post-operatively and gradually improved to the pre-operative stage. There was 1 case of deep wound infection and no case of pseud-arthrosis, instrument failures or mortality.Results indicate that in patients with neuromuscular scoliosis, acceptable amounts of curve correction can be achieved and maintained with posterior-only pedicle screw instrumentation without anterior release procedure.The prevalence of severe spinal deformity in patients with neuromuscular disorders is estimated between 50% and 8
Intraoperative blood loss during different stages of scoliosis surgery: A prospective study
Hitesh N Modi, Seung-Woo Suh, Jae-Young Hong, Sang-Heon Song, Jae-Hyuk Yang
Scoliosis , 2010, DOI: 10.1186/1748-7161-5-16
Abstract: We prospectively analyzed the estimated blood loss (EBL) and operation time over four stages of scoliosis surgery in 44 patients. The patients were divided into three groups: adolescent idiopathic (group 1), spastic neuromuscular (group 2) and paralytic neuromuscular (group 3). The per-level EBL and operation times of the groups were compared on a stage-by-stage basis. The bone marrow density (BMD) of each patient was also obtained, and the relationship between per-level EBL and BMD was compared using regression analysis.Per-level operation time was similar across all groups during surgical stage (p > 0.05). Per-level EBL was also similar during the dissection and bone-grafting states (p > 0.05). However, during the screw insertion stage, the per-level EBL was significantly higher in groups 2 and 3 compared to group 1 (p < 0.05). In the correction stage, per-level EBL was highest in group 3 (followed in order by groups 2 and 1) (p < 0.05). Preoperative BMD indicated that group 3 had the lowest bone quality, followed by groups 2 and 1 (in order), but the preoperative blood indices were similar in all groups. The differences in bleeding patterns in the screw insertion and correction stages were attributed to the poor bone quality of groups 2 and 3. Group 3 had the lowest bone quality, which caused loosening of the bone-screw interface during the correction stage and led to more bleeding. Patients with a T-score less than -2.5 showed a risk for high per-level EBL that was nine times higher than those with scores greater than -2.5 (p = 0.003).We investigated the blood loss patterns during different stages of scoliosis surgery. Patients with poor BMD showed a risk of blood loss nine times higher than those with good BMD.Underlying disorders play major roles in determining blood loss during surgical procedures. In particular, patients with neuromuscular diseases are thought to be at risk for increased blood loss during scoliosis surgery, but most reports addressing this q
Design and Simulation of Two Stage OTA Using 0.18μm and 0.35μm Technology
Hitesh Modi,Nilesh D. Patel
International Journal of Engineering and Advanced Technology , 2013,
Abstract: The OTA is an amplifier whose differential input voltage produces an output current. Thus, it is a voltage controlled current source. Operational transconductance amplifier is one of the most significant building-blocks in integrated continuous-time filters. Here we design a two stage operational transconductance amplifier in TSMC 0.18μm and 0.35μm technology with all the transistor in the saturation region. The simulated output frequency response is shown for a supply voltage of 1.8V and 3.3V using IC studio in Mentor Graphics. DC gain is 47.86dB and 46.75dB, power consumption is 2mW and 3.2mW and slew rate is 37.58 V/μs and 31.67 V/μs for 1.8V and 3.3V respectively.
Epidural cement leakage through pedicle violation after balloon kyphoplasty causing paraparesis in osteoporotic vertebral compression fractures - a report of two cases
Si-Young Park, Hitesh N Modi, Seung-Woo Suh, Jae-Young Hong, Won Noh, Jae-Hyuk Yang
Journal of Orthopaedic Surgery and Research , 2010, DOI: 10.1186/1749-799x-5-54
Abstract: Osteoporotic vertebral compression fracture (OVCF) is the commonest complication of osteoporosis[1]. Over the past two decades, vertebroplasty was developed to stabilize OVCF without increasing morbidity and mortality associated with open surgery[2,3]. Diamond and colleagues. [4] noted that vertebroplasty for acute compression fracture was significantly better than nonoperative treatment in terms of pain relief, level of function, and hospital stay. However, complications related with vertebroplasty are not uncommon such as cement extravasation, pulmonary embolism, infection, epidural hematoma, systemic toxicity, and vertebral body fractures [5-17]. Among the commonest complications, cement extravasation has been estimated in 70% cases for vertebroplasty procedures [18,19]. Most of the time it is asymptomatic; however, disastrous complications causing paraparesis have been also reported in the literature [10,15,19].Kyphoplasty, as a modification of vertebroplasty, has theoretical advantages such as focal kyphosis correction and diminished risk of cement extravasation due to lower cement injection pressures [9,11,20-22]. Backer et al. [23] reported that out of 100 balloon kyphoplasties, overall cement leakage rate was 31%. Most leakages were anterior and superior; only 2% were posterior and most leakages were below 3 mm. The biomechanical principle of increasing anterior column load with progressing kyphosis leading to subsequent vertebral compression fracture has established the basic rationale for kyphoplasty [24]. Probably that is the reason for increasing use of kyphoplasty procedures for OVCF now a day. Even though kyphoplasty has significantly lower rates of cement extravasations than vertebroplasty [21], cement leakage may occur more frequently than originally appreciated, and often associated with significant morbidity [25]. There are numerous descriptions of significant spinal cord or cauda equina injuries associated with vertebroplasty procedures; however,
Bone quality and growth characteristics of growth plates following limb transplantation between animals of different ages - Results of an experimental study in male syngeneic rats
Hitesh N Modi, Seung Suh, Boopalan Prjvc, Jae-Young Hong, Jae-Hyuk Yang, Young-Hwan Park, Jae-Moon Lee, Yong-Hyon Kwon
Journal of Orthopaedic Surgery and Research , 2011, DOI: 10.1186/1749-799x-6-53
Abstract: Ten juvenile to juvenile and five juvenile to adult hind limb transplants were performed in male syngeneic Lewis rats. Upper tibial bone density in isochronograft and heterochronograft limbs was measured by 3D micro-CT and compared with that of the opposite non-operated limbs.We observed inferior bone quality (p < 0.05) in heterochronografts compared to isochronografts. After transplantation, isochronografts did not exhibit increases in tibial lengths compared to opposite juvenile non-operated tibias (p = 0.66) or heterochronograft tibias (p = 0.61). However, significant differences were observed between heterochrongraft tibial lengths when and opposite adult non operated tibial lengths (p < 0.001).Age dependent alterations affect bone quality, resulting in post transplantation osteoporosis in heterochronografts, but not isochronografts. However, the growth plates of transplanted limbs retain their properties of longitudinal growth and continue to grow at the same rate.Osteoporosis often develops in transplanted and grafted bone after bone transplantation or grafting [1-4] due to revascularization and creeping substitution that occur during the repair process. Kline et al. [1] proposed that lack of weight bearing post transplantation and subsequent stress shielding are the causative factors of post transplantation osteoporosis.Increases in the length of long bones occur by enchondral ossification at the growth plates (metaphyses). Each growth plate has an inherent mechanism for determining growth rate and limb morphology [1]. In addition, growth at the physes is influenced by a variety of hormones that have permissive effects and enable the growth plated to achieve their maximum growth potential. C growth hormone, thyroxine, somatomedin C (insulin like growth factor I), insulin like growth factor II, cortisol, insulin, and sex hormones all play important roles in regulating growth plate development and rates of limb growth [5-9]. There is a complex interaction betwe
Surgical complications in neuromuscular scoliosis operated with posterior- only approach using pedicle screw fixation
Hitesh N Modi, Seung-Woo Suh, Jae-Hyuk Yang, Jae Cho, Jae-Young Hong, Surya Udai Singh, Sudeep Jain
Scoliosis , 2009, DOI: 10.1186/1748-7161-4-11
Abstract: Fifty neuromuscular patients (18 cerebral palsy, 18 Duchenne muscular dystrophy, 8 spinal muscular atrophy and 6 others) were divided in two groups according to severity of curves; group I (< 90°) and group II (> 90°). All underwent PSF and SSI with pedicle screw fixation. There were no anterior procedures. Perioperative (within three months of surgery) and postoperative (after three months of surgery) complications were retrospectively reviewed.There were fifty (37 perioperative, 13 postoperative) complications. Hemo/pneumothorax, pleural effusion, pulmonary edema requiring ICU care, complete spinal cord injury, deep wound infection and death were major complications; while atelectesis, pneumonia, mild pleural effusion, UTI, ileus, vomiting, gastritis, tingling sensation or radiating pain in lower limb, superficial infection and wound dehiscence were minor complications. Regarding perioperative complications, 34(68%) patients had at least one major or one minor complication. There were 16 patients with pulmonary, 14 with abdominal, 3 with wound related, 2 with neurological and 1 cardiovascular complications, respectively. There were two deaths, one due to cardiac arrest and other due to hypovolemic shock. Regarding postoperative complications 7 patients had coccygodynia, 3 had screw head prominence, 2 had bed sore and 1 had implant loosening, respectively. There was a significant relationship between age and increased intraoperative blood loss (p = 0.024). However it did not increased complications or need for ICU care. Similarly intraoperative blood loss > 3500 ml, severity of curve or need of pelvic fixation did not increase the complication rate or need for ICU. DMD patients had higher chances of coccygodynia postoperatively.Although posterior-only approach using pedicle screw fixation had good correction rate, complications were similar to previous reports. There were few unusual complications like coccygodynia.Progressive spinal deformities are common in patie
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