OKOJ, Volume 12, No. 5

Radiation Exposure in Pediatric Orthopaedic Imaging

In recent years, advances in imaging technology have led to greater utilization of radiography, CT, and other imaging studies among medical practitioners. This has perhaps occurred most notably with the use of CT scans. However, the benefits that these studies provide in diagnostic insight must be weighed against their potential risks to patients, specifically in terms of radiation exposure. Thus, for example, although the effective dose of radiation in CT studies of distal anatomic elements is relatively low, the dose to more proximal structures can be more significant. Computed tomographic scanning of the spinal column and pelvis in particular imparts an effective dose of radiation that is an order of magnitude higher than that delivered in radiographic studies. In the future, research studies may attempt to better correlate patients’ clinical outcomes with the expenditure of radiation in different types of imaging studies.

    • Keywords:
    • radiation

    • multidetector computed tomography

    • radiography

    • computed tomography

    • magnetic resonance imaging

    • tissue weighting factor

    • radiosensitivity

    • specificity

    • effective-dose radiation

    • Subspecialty:
    • Pediatric Orthopaedics

Tissue Engineering of the Intervertebral Disk

The symptomatic degeneration of intervertebral disks is a common and multifactorial clinical problem that imposes a significant physical and economic burden on society. The degenerative process is characterized by aberrant changes in the cellular composition and biochemical components of the extracellular matrix of the disk. The pathogenesis of disk degeneration is complex and still being elucidated. In the realm of treatment of disk degeneration, spinal fusion is controversial because of the variability in its clinical outcomes and its alteration of the biomechanics of the spine. Tissue engineering has emerged as an attractive alternative to surgery for treating disk degeneration, as an attempt to restore the functional and the physiologic characteristics of the intervertebral disk. Numerous strategies have been devised in preclinical and animal models for restoring or replacing the nucleus pulposus, anulus fibrosus, and whole disk. This article reviews the advances that have been made and obstacles that remain in tissue engineering for treating degeneration of the intervertebral disk.

    • Keywords:
    • intervertebral disk

    • protein therapy

    • gene therapy

    • stem cells

    • degeneration

    • tissue engineering

    • Subspecialty:
    • Basic Science

Arthroscopic Treatment of Scapulothoracic Bursitis

Scapulothoracic bursitis, also known as snapping scapula syndrome, is a clinical disorder characterized by painful motion and crepitus at the scapulothoracic articulation, often accompanied by an audible and palpable snapping of the scapula as it moves over the thoracic wall. The disorder commonly affects young, active patients and overhead athletes, and is associated with scapular dyskinesis of any cause, interposing soft-tissue or osseous masses, aberrant scapular morphology, and abnormalities of the chest wall. Physical therapy, anti-inflammatory medications, and scapulothoracic injections of corticosteroid are the mainstays of nonsurgical treatment and are commonly successful in alleviating symptoms. Patients who remain symptomatic despite a course of nonsurgical care may be considered for surgery, including arthroscopic or open bursectomy and partial scapular resection. Results of surgical treatment reported in the literature are generally good, although well-designed studies are still being defined.

    • Keywords:
    • scapulothoracic bursitis

    • snapping scapula syndrome

    • arthroscopy

    • Subspecialty:
    • Shoulder and Elbow