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1 Ne wyo r k-pr e s b y t e r i a n Columbia Orthopaedics Affiliated with Columbia University College of Physicians and Surgeons inside FALL 2010 Batter Up 2 NewYork-Presbyterian: Official Hospital of the New York Yankees. Hip Surgery Arthroscopic Hip Surgery Gets Patients Moving Sooner. 3 Gift of Voice A Night of Arias for Orthopaedic Cancer Research 4 Welcome Back Joint Replacement 5 Specialist Returns to NewYork-Presbyterian Early Onset Scoliosis A New Approach to Reversing Scoliosis 6 Save THE DATE 74th NYOH Alumni Meeting New York City May 20-21, 2011 Guest speakers: Gary E. Friedlaender, MD Robert H. Cofield, MD Distinguished Alumnus: William G. Hamilton, MD NYOH Residency Graduation New York City June 17, 2011 Visiting Professor: William J. Maloney, MD For more information on Columbia Orthopaedics services, visit nyp.org/columbiaortho Surgeon Travels to Perform Complex Spinal Surgeries 13-year-old girl from Ethiopia presented with a A 130 scoliosis of the spine. (Fig. 1) She had one surgery at age 1, but was still left with such severe curvature that it impaired her respiratory function. After a complex procedure performed by Yongjung Jay Kim, MD, in Ghana, she wrote, I cannot thank you enough for my new life. I thought that if she does something good with her life, that s plenty of thanks for me, said Dr. Kim. To perform the scoliosis surgery, he used traction and posterior-only instrumentation and removed the posterior facet joints and apical ribs. Such facetectomy and rib resection increase spinal mobility during the procedure. He inserted cobalt chrome rods anchored with titanium screws to straighten the spine during the six-hour surgery. The patient s respiratory function was only 20 percent before surgery; normal is more than 85 percent, and severely impaired lung function is less than 30 percent. She required assisted ventilation for a few days after surgery, and respiratory and physical therapy to learn how to adapt to her new posture. Dr. Kim also donated his talents to correct a 140 kyphosis in a 9-year-old boy from Sierra Leone who developed severe curvature as a result of tuberculosis. (Fig. 2) Seven vertebral bodies (T4 to T10) became melded together. In this patient, Dr. Kim could not use traction because it is associated with a risk of spinal cord paralysis in such cases. Instead, he employed vertebral column resection, removing the affected vertebral bodies via a posterior approach. He A B C Resources for Professionals Webcasts CME Activities Medical Presentations Specialty Briefings Newsletters Visit nyp.org/pro TO Subscribe to our Pediatric Orthopaedic Newsletter, go to columbiaortho.org/children D E F Fig year old girl presents with a 130 congenital scoliosis with poor respiratory function.(a-c) She had one surgery at age 1, but was still left with a severe curvature (3cm distance between right axilla and pelvis). Posterior-only instrumentation and fusion following intraoperative traction corrected her deformity significantly.(d-f)

2 then inserted a mesh cage in place of each resected vertebra, eliminating the hump and restoring the boy to upright posture. Dr. Kim completed a two-year Spine/ Scoliosis fellowship in He has traveled once or twice each year since 2008 to donate his time and services to help patients in Africa and Asia with severe spinal deformities. An authority on highly complex spinal surgeries, Dr. Kim has won numerous honors and awards from the Scoliosis Research Society and Cervical Spine Research Society. The nonprofit organization FOCOS (The Foundation of Orthopedics and Complex Spine, founded by Dr. Oheneba Boachie- Adjei) connected Dr. Kim with the African scoliosis and kyphosis patients. The mission of FOCOS is to provide comprehensive, affordable orthopedic and spine care to underserved communities in Ghana and throughout West Africa. These complex spinal surgeries are best suited for young patients, who stand to benefit not only in terms of form but also lung function more so than elderly patients. Few surgeons perform these complex procedures, noted Dr. Kim. It is the most technically demanding spinal surgery. I am grateful my expertise can help these young patients live better lives. A B C D E F Fig. 2-9 year old boy presents with a 140 kyphosis (normal: kyphosis) as a result of spine tuberculosis.(a-d) Seven vertebral bodies (T4 to T10) were fused. Posterior vertebral column resection, removing the affected vertebral bodies via a posterior approach and inserting a mesh cage packed with bone in place of resected vertebra, eliminated the hump and restored the boy to upright posture.(e, F) NewYork-Presbyterian Columbia Orthopaedics Editorial Board Columbia University College of Physicians and Surgeons NewYork-Presbyterian Columbia Orthopaedics is a semi-annual newsletter published by NewYork-Presbyterian Hospital. The articles in this newsletter represent the work of the Columbia University College of Physicians and Surgeons faculty at NewYork-Presbyterian Hospital/ Columbia University Medical Center, who are at the forefront of research and practice in the diagnosis, treatment, and rehabilitation of musculoskeletal conditions in adults and children. Peter Tang, MD, MPH Editor-in-Chief Assistant Attending Orthopaedic Surgeon Assistant Professor of Orthopaedic Surgery pt2214@columbia.edu Louis U. Bigliani, MD Chief, Orthopaedic Surgery Service Director, Center for Shoulder, Elbow and Sports Medicine President, Medical Board Frank E. Stinchfield Professor and Chairman Department of Orthopaedic Surgery lub1@columbia.edu Francis Y. Lee, MD Chief, Tumor and Bone Disease Service Associate Professor of Clinical Orthopaedic Surgery Vice Chairman for Research Director, Center for Orthopaedic Research fl127@columbia.edu William N. Levine, MD Director, Sports Medicine Associate Director, Center for Shoulder, Elbow and Sports Medicine Vice Chairman of Educaiton and Professor of Clinical Orthopaedic Surgery wnl1@columbia.edu William B. Macaulay, MD Director, Center for Hip and Knee Replacement Anne Youle Stein Professor of Clinical Orthopaedic Surgery wm143@columbia.edu Christopher B. Michelsen, MD Chief, Orthopaedic Spine Service Chief, Orthopaedic Surgery The Allen Hospital Professor of Clinical Orthopaedic Surgery cbmmd@yahoo.com Melvin P. Rosenweasser, MD Director, Orthopaedic Hand and Trauma, and Microsurgery Services Robert E. Carroll Professor of Hand Surery mpr2@columbia.edu David P. Roye, MD Chief, Pediatric Orthopaedic Surgery Morgan Stanley Children s Hospital St. Giles Professor of Clinical Pediatric Orthopaedic Surgery dpr2@columbia.edu 2 nyp.org/columbiaortho

3 Batter Up: NewYork-Presbyterian Hospital/Columbia University Medical Center is the Official Hospital of the NY Yankees The desk of Christopher Ahmad, MD, sits in what used to be the outfield of the first baseball stadium that served as home field for the New York Yankees. The World Series Champions got their start in Washington Heights when the Hilltop Ball Park opened there in 1903; the Yankees got their name because they were the team located north of the New York Giants. So more than a century later, it is only fitting that NewYork-Presbyterian/ Columbia should be the official hospital of the Yankees, a designation acquired in Dr. Ahmad, whose training includes a fellowship in baseball-related orthopaedics, is the Head Team Physician and only the fourth physician to obtain that title in the history of the franchise. In this role, Dr. Ahmad is on site at Yankee Stadium for every home game, attending to the needs of the Yankees as well as the visiting team. (Physicians for other teams extend the same courtesy by treating the Yankees when they are the visiting team.) He evaluates and treats all injuries sustained during a game, taking x-rays when needed and referring players for other tests such as MRIs. He is proud of supporting the Yankees through their victory in the World Series in 2009, his own rookie year with the Yankees. Ahmad s work with the Yankees is yearround. During the off-season following the 2008 season, he performed all pre-signing physical examinations on players who joined the 2009 World Series club. He flies back and forth from New York to Tampa for spring training and performs preseason physicals on all the major league players. When Alex Rodriguez complained of hip pain during spring training, Dr. Ahmad flew to Tampa, diagnosed a labral tear, and coordinated his care. This is the most recognized baseball franchise in the world, with more championships than any other team in any sport, and the health of the team can have a great impact on their success. Christopher Ahmad, MD Christopher Ahmad, MD and Joe Girardi, Manager of the New York Yankees. During the season, hamstring strains commonly occur, and affected about five players last year. To diagnosis and treat these injuries, Dr. Ahmad obtains immediate MRI scans to grade the injury and provides platelet-rich plasma therapy to accelerate and make healing of the injured soft tissues more predictable. Injury prevention is another major focus. And when a player is injured, Dr. Ahmad along with the athletic trainers counsel the team regarding return to play so the manager and general manager can modify the player roster in the most effective way. Dr. Ahmad s interest in orthopaedics as it relates to baseball stems back to his undergraduate days as a mechanical engineering major at Columbia University, when he worked in the Biomechanics Research Laboratory at the Center for Orthopaedic Research a lab which he now directs studying how ligament and tendon injuries occur and how to treat them. He pursued sports medicine as a resident at Columbia and completed a fellowship at the Kerlan-Jobe Orthopaedic Clinic in Los Angeles. Dr. Frank Jobe was the surgeon who reconstructed the torn ulnar collateral ligament of the pitching elbow of Los Angeles Dodger Tommy John in Dr. Ahmad learned the technique from Dr. Jobe himself, and he has become an authority on this procedure, producing book chapters, scientific articles, and videos about the approach. Today the Yankees are benefiting from his expertise. The amount of force generated inside the pitcher s elbow is so immense that theoretically the ligament should break every time a pitcher throws, noted Dr. Ahmad. The Tommy John surgery can now reliably correct what used to be a career-ending injury. The New York Yankees opened their first game at the Bronx location in 1923, and the groundbreaking of Columbia-Presbyterian Medical Center (present day NewYork- Presbyterian/Columbia University Medical Center) occurred three years later. Today visitors can spy a commemorative home plate in the medical center s garden on Fort Washington Avenue at 166th Street, which was dedicated by the Yankees. This is the most recognized baseball franchise in the world, with more championships than any other team in any sport, and the health of the team can have a great impact on their success, said Dr. Ahmad. Our goal is to keep players healthy, and when they re injured, get them back to playing as quickly and safely as possible something that not only helps the individual player, but also the team s quest for a championship. 3

4 Minimally Invasive Hip Surgery Get Patients Moving Sooner Labral tears of the hip can occur as a result of wear-and-tear in some individuals and following rotational or traumatic injury in others. Hip arthroscopy, available at NewYork-Presbyterian/Columbia University Medical Center, is a minimally invasive approach used to treat labral tears which potentially enables patients to return to their normal activities sooner than conventional open surgery. This joint preservation technique may theoretically help prevent the need for hip replacement surgery in patients who have sustained labral tears. The fibrocartilaginous labrum of the hip provides a vital interface between the acetabulum and femoral head. Patients who have cam impingement due to excess bone at the femoral head-neck junction or pincer impingement due to regional over-coverage of the femoral head from excessive bone at the acetabular rim are at increased risk for labral tears. These conditions are categorized as femoroacetabular impingement. Furthermore, trauma to the affected hip (such as hip dislocation) or repetitive rotational injury (for example, during certain sports with repetitive pivoting, such as soccer, hockey, running, or skiing) can also tear the labrum. Professional baseball player Chase Utley and quarterback Kurt Warner both suffered labral tears in recent years which were addressed surgically with hip arthroscopy. The labrum is an important stabilizer for the hip, explained Edwin Cadet, MD, who underwent specialized training in hip arthroscopy during his sports medicine surgery fellowship. Furthermore, it also serves as an important structure in preserving the health of the cartilaginous surfaces of the hip through its fluid seal properties. Labral tears typically present as groin pain, but can also cause referred pain to the knee or buttocks. MRI is typically used to visualize the labrum, while radiographs and CT scans are obtained to better characterize skeletal anatomy, such as excess bone at the femoral head-neck junction or the acetabular rim. The optimal candidates for hip arthroscopy are younger patients without pre-existing osteoarthrosis. Posterior cam lesions and severe acetabular or femoral head deformity may not be adequately addressed using arthroscopic techniques. Traction of the affected extremity and specialized long arthroscopic instruments are used in hip arthroscopy to facilitate access and work within the joint. The labrum is an important stabilizer for the hip. Furthermore, it also serves as an important structure in preserving the health of the cartilaginous surfaces of the hip through its fluid seal properties. Edwin Cadet, MD Using arthroscopy, the surgeon can either repair or debride the labrum. The decision to repair or debride the labrum is dependent A B D on the type of tear and the quality of tissue encountered at the time of surgery, noted Dr. Cadet. During a labral repair, the surgeon uses suture anchors and suture-tying techniques to adhere the labrum to the acetabular rim. (Fig. 1A) With debridement, the surgeon excises frayed labral tissue. (Fig. 1B, C) Cam or pincer impingement can also be addressed at the same time as labral debridement or repair using arthroscopic techniques. (Fig. 1D, E ) Hip arthroscopy is also useful for removal of loose bodies such as those due to a fracture, dislocation, synovial chondromatosis, or Legg- Calve-Perthes disease (an osteonecrosis of the hip that occurs in children). Patients with iliopsoas tendinitis, snapping hip syndrome, and recalcitrant greater trochanteric bursitis may also benefit. Hip arthroscopy can also be used to stage avascular necrosis of the femoral head. Fig. 1 Arthroscopic picture demonstrates example of a hip labral repair.(a) Example of a hip labral tear in a 28-year old symptomatic runner before debridement (B, red arrow) and after arthroscopic debridement (C). Example of CAM impingement (demonstrated by soft tissue ablator and red arrow) in a symptomatic 19-year old collegiate basketball player prior to decompression (D) and after arthroscopic decompression (E). (F/FH; femoral head, L; labrum. A; acetabulum, FN; femoral neck) C E 4 nyp.org/columbiaortho

5 Because arthroscopy does not require osteotomy of the greater trochanter and/or open surgical dislocation to gain access to the hip joint, patients can generally return to sports in 4 to 6 months after surgery. Like other minimally invasive procedures, arthroscopy is also associated with smaller incisions, less blood loss, and less postoperative pain. It is an outpatient procedure, compared to inpatient admission with open surgical dislocation techniques. Approximately four months of physical therapy are necessary after arthroscopic treatment of labral tears and femoroacetabular impingement to help patients regain strength and function specific to their sport. Hip arthroscopy is a technically demanding surgical approach that requires specialized training, and we are glad to be able to offer it to our patients, concluded Dr. Cadet. The indications for this procedure are expanding as we gain more knowledge of hip pathology. A Gift of Voice for Musculoskeletal Cancer Research Some 150 patients, families, healthcare professionals, and guests were treated to an evening of operatic arias on March 24, courtesy of Italian lyric tenor Luciano Lamonarca. The free concert took place in the Wintergarden of NewYork-Presbyterian Morgan Stanley Children s Hospital. The event was organized to support the cancer patients and musculoskeletal cancer research at the Center for Orthopaedic Research (COR). The COR was established in 2004 by Louis U. Bigliani, MD, Professor and Chair, Department of Orthopaedic Surgery at NewYork-Presbyterian Hospital/Columbia University Medical Center. Dr. Bigliani has made special efforts to provide optimal environments for orthopaedic surgeons to conduct translational research. Francis Y. Lee, MD, PhD, has been leading translational research at the COR. Dr. Lee is Chief of Musculoskeletal Oncology, Associate Professor with Tenure, and Vice Chair for Research, Department of Orthopaedic Surgery at NewYork-Presbyterian/Columbia. Mr. Lamonarca, whom the Italian media describes as following in the footsteps of Pavarotti, has performed internationally in support of many worthy causes. While in Italy, his mother suffered from colon cancer and died several years ago. Mr. Lamonarca had an occasion to perform in the hospital where his mother received her care. Ever since, he has been donating his time and sharing his talents by performing in support of cancer patients and cancer research. He also serves as President of the Puglia Center of America, which sponsored the concert. The Puglia Center of America was established to promote the Italian region of Puglia in all aspects, especially through cultural, educational, and touristic exchanges between the United States. The organization s goal is to organize artistic events that support the United Nations Millennium Development Goals and various missionary projects, An evening of Italian Opera Arias hosted in honor of Dr. Francis Y. Lee and the Center for Orthopaedic Research. Left to right: Asami Tamura, pianist, Valentina Popa, performer, Luciano Lamonarca, tenor, Dr. Lee and Nicole Muller, patient and emcee. One of the goals of the concert was to increase awareness of musculoskeletal cancers which have not drawn much public attention. That goal was very well accomplished. Francis Y. Lee, MD especially those directed against cancer. One of the goals of the concert was to increase awareness of musculoskeletal cancers, said Dr. Lee. It was an honor to have Luciano perform on behalf of the orthopaedic research efforts of the Center for Orthopaedic Research, and we thank him for donating his time and talent. Cancers of the bone and muscle account for 15 percent of all cancers in children; however, their impact on life is significant because they often have a poor prognosis. Bone cancer often presents as a secondary cancer and can arise from breast, prostate, lung, kidney, and thyroid cancers and melanoma. Most musculoskeletal tumors are resistant to radiation therapy and chemotherapy. At the COR, Dr. Lee is investigating the cellular and molecular processes underlying such resistance to treatment. As a highly regarded clinician-scientist, he is one of only a few orthopaedic surgeons in the United States to have received R01 funding from the National Institutes of Health. As an orthopaedic oncology specialist, he is committed to the care of pediatric and adult patients with primary and metastatic bone cancers and to research that will improve patient outcomes. 5

6 Jonathan Lee, MD, Returns to NewYork-Presbyterian/Columbia Jonathan Lee, MD, has been appointed Assistant Professor of Clinical Orthopaedic Surgery at NewYork-Presbyterian Hospital/ Columbia University Medical Center, where he will begin practicing on September 1, Dr. Lee did his residency at NewYork- Presbyterian/Columbia and recently completed a fellowship in adult reconstruction and joint replacement. He specializes in total hip and knee replacement. Dr. Lee explained how the change from cemented to uncemented hip implants has increased the longevity of implants. The titanium or hydroxyapatite coating on the surface of a metal implant enhances the interface with the bone. The bone is able to interdigitate into the spaces of the metal, he noted. In addition to metal on plastic, newer implants are composed of metal on metal or ceramic on ceramic. Hip and knee replacements typically have a 20 to 30-year life span. But as more people have total hip and knee replacements at an earlier age, such as Baby Boomers, Dr. Lee said there will be an increased need for implant revisions. There is a whole new group of people having these procedures earlier because they do not want to live with disability, he said. But implants were not designed for that type of longevity, and there will be a rash of revisions later on. Revisions do not do as well as primary joint replacements. Dr. Lee is evaluating computer navigation to register points on a patient s anatomy as a means of enhancing the precision of implant placement. This approach may reduce the degree of error from 3 degrees through conventional methods to just 1 degree. If we can place implants more accurately, we may be able to improve implant longevity and patient outcomes over time, he explained. Computer navigation adds just 5 to 15 minutes and a small cost to each case. Additionally, he is assessing computer navigation used with a robotic arm to make very precise bone cuts for joint replacements. This approach may be employed during a technique called MAKOplasty to allow unicondylar knee replacement in select patients. Dr. Lee is also utilizing computer navigation as a teaching model to help train residents and surgeons on the placement of the acetabular shell during hip replacement. The trainees put the shell in place in a plastic pelvis model, and then use computer navigation to check their placement. This is a crucial part of the operation because there can be lots of variability, which will affect patient outcome, he noted. His interest in orthopaedics began while he was an undergraduate student at Brown University. He spent his summers working in a laboratory at the State University of New York-Stony Brook, near his family s Long Island home, where he studied how electromagnetic fields influence bone cells in vitro to see how electric currents could potentially affect bone healing. He was also able to shadow the doctors with whom he worked. After completing medical school at Brown, Dr. Lee completed his orthopaedic surgery residency at Columbia University College of Physicians and Surgeons. I chose orthopaedics because there is something concrete we can do for our patients that can really make a difference in their lives, he said. I love joint replacement in particular because it s an extreme example of that patients can come in complaining of debilitating pain, and within days of hip replacement surgery, they say that their pain is gone. The integration of clinical care, research, and education at NewYork-Presbyterian/ Columbia influenced Dr. Lee s decision to return after his fellowship. It s one cohesive group where there is a lot of cross-talk between subspecialties and there is a strong academic focus, which I enjoy, he said. These connections were crucial in my decision to return to Columbia, and I am looking forward to collaborating with colleagues who were my mentors when I was a resident. Latest Treatment Options for Early Onset Scoliosis Spinal Stapling, VEPTR, and Growing Rods Among the Latest Treatment Options for Early Onset Scoliosis Patients with early onset scoliosis can develop severe, complex spinal deformity that distorts and reduces the volume of the thorax. The resulting condition can compromise respiratory function and be life-threatening. The Center for Early Onset Scoliosis at NewYork- Presbyterian Morgan Stanley Children s Hospital is one of only a few hospitals in the country to offer new, minimally invasive treatment alternatives, such as spinal stapling, Vertical Expandable Prosthetic Titanium Rib VEPTR, and growing rods, which promise improved outcomes. Tens of thousands of children in the U.S. are diagnosed with scoliosis each year. When the curvature is moderate, spinal braces can be used to slow or decrease the chance of progression. Until now, however, there was no way to reverse progression and straighten the spine. Spinal Stapling Spinal stapling is a two-hour surgery that involves implanting inch-long metallic staples across the growth plates of the spine. (Fig. 1A, B) Made of a temperature-sensitive While most children do well with spinal fusion, we are on the cusp of a new era in the treatment of scoliosis. For the first time, we have a way to potentially reverse the scoliosis. Michael G. Vitale, MD 6 nyp.org/columbiaortho

7 metal alloy, the staples are implanted using a thoracoscope, a camera that is inserted into the chest, resulting in a very limited incision and minimal scar. The procedure is available to children with progressive moderate scoliosis (less than 30 degrees) who are still growing (girls up to age 14 and boys up to age 16). Through anterior growth modulation, we feel that it will be possible to stop the curve from developing and in fact, allow the curve to reverse itself, said Michael G. Vitale, MD, MPH. While most children do well with spinal fusion, we are on the cusp of a new era in the treatment of scoliosis. For the first time, we have a way to potentially reverse the scoliosis. According to Dr. Vitale, early fusion is not the preferred choice for treatment. He recently presented findings at the International Conference on Early Onset Scoliosis, that spinal fusion in young children can lead to significant issues in quality of life and pulmonary function over the long term. The study followed 27 patients who received spinal fusion, and after 10 years, their pulmonary function and reported quality of life were significantly less than that of a healthy child. VEPTR and Growing Rods Other new strategies have evolved that allow growth of the spine and growth of the thorax. The Vertical Expandable Prosthetic Titanium Rib (VEPTR) straightens the spine and opens a larger space for the lungs and other internal organs to grow by placing a titanium brace between two ribs to push them apart. VEPTR is a new device which in the last 10 years has shown very positive results in a select group of patients that not only treats the curvature, but allows us to treat the chest wall deformity and the thoracic insufficiency that is so often present in these children, said Dr. Vitale. Growing rods attached to the spine and affixed to vertebrae at the top and the bottom can be expanded over time using a mechanism that allows the lengthening to be performed in a simple outpatient surgery. The approach minimizes spinal deformity, and most importantly allows lung development to occur to preserve a normal life span for the patient. Results of growing rods have been generally positive, said Dr. Vitale. A number of authors have, in fact, shown that the use of growing rods allows us to control large curves to expand the thorax, to allow the thoracic spine to grow with some, but relatively acceptable complications. From their experience, Dr. Vitale and his colleagues maintain that there are a number of general principles that promise optimum outcomes and success in the use of growing rods. The use of dual rods is particularly important. Stable foundations based on pedicle screw constructs allow us a more solid area for support, noted Dr. Vitale. Long constructs allow us to share the load and share the stress of these constructs over time. Frequent lengthening is also an extremely important part of this concept, said David P. Roye, Jr., MD. We lengthen every four Fig. 1 Pre-operative xray of a 10-year-old female with Juvenile Idiopathic Scoliosis and with significant growth remaining.(a) She underwent anterior vertebral stapling with a 4 cm incision and was discharged home on post-operative day #2. Post-operative xray at 3 months shows the staples in place and reversal of the curve which bodes well for avoiding fusion.(b) Results of growing rods have been generally positive. A number of authors have, in fact, shown that the use of growing rods allows us to control large curves to expand the thorax, to allow the thoracic spine to grow with some, but relatively acceptable complications. Michael G. Vitale, MD A months in children less than 3, and then as they get older, we can cut back to every six months. The concept for waiting for the curve to progress prior to lengthening is probably not the right one. We should be looking to have regularly scheduled lengthening to allow maximal growth of the spine. Hybrid Technique: Spinal Stapling and VEPTR For children with larger curves, the benefits of growing instrumentation Growing Rods or VEPTR can be combined with spinal stapling. This new hybrid technique is being applied for curves greater than 35 degrees and patients are showing tremendous outcomes. Children return to active vibrant lives just months after surgery. Adjustments are made every six to nine months during their growth periods and are usually performed on an outpatient basis. Having the full gamut of options from growing rods to limited fusion to VEPTR allows us to cater the specific treatment and implant approach, implant choices that were not available even five or 10 years ago, to the needs of our patients, said Dr. Vitale. The menu of treatment options is much greater than ever before, and we have the ability to promise significantly different and hopefully, better results for children with early onset scoliosis. B 7

8 NewYork-Presbyterian Hospital 622 West 168th Street New York, NY Nonprofit Org. U.S. Postage PAID Permit No New York, NY Ne wyo r k-pr e s b y t e r i a n Columbia Orthopaedics Affiliated with Columbia University College of Physicians and Surgeons Important news from NewYork-Presbyterian Hospital at the forefront of research and clinical care in the diagnosis, treatment, and rehabilitation of musculoskeletal conditions in adults and children. Contributing Faculty The following is a list of the medical professionals quoted in this issue of the NewYork-Presbyterian Columbia Orthopaedics Newsletter. For more information on their work, please contact them at the addresses listed. NewYork-Presbyterian Hospital Columbia University College of Physicians and Surgeons Christopher Ahmad, MD Head Team Physicain New York Yankees Director of Biomechanics Research Center for Orthopaedic Research Associate Professor of Clinical Orthopaedic Surgery Associate Attending Orthopaedic Surgeon Director of the Center for Pediatric and Adolescent Sports Medicine NewYork-Presbyterian Morgan Stanley Children s Hospital csa4@columbia.edu Edwin Cadet, MD Assistant Professor of Clinical Orthopaedic Surgery Assistant Attending Orthopaedic Surgeon ec2195@columbia.edu Yongjung Jay Kim, MD Assistant Professor of Clinical Orthopaedic Surgery Assistant Attending Orthopaedic Surgeon Chief of Spinal Deformity Surgery yongjungjaykim@gmail.com Francis Lee, MD, PhD Chief of Musculoskeletal Oncology Associate Professor with Tenure Vice Chair for Research, Department of Orthopaedic Surgery fl127@columbia.edu Jonathan Lee, MD Assistant Attending Orthopaedic Surgeon Assistant Professor of Clinical Orthopedic Surgery Jlee1017@gmail.com David P. Roye, Jr., MD Chief of Pediatric Orthopaedic Surgery NewYork-Presbyterian Morgan Stanley Children s Hospital St. Giles Professor of Pediatric Orthopedic Surgery dpr2@columbia.edu Michael G. Vitale, MD, MPH Chief of Pediatric Spine and Scoliosis Surgery NewYork-Presbyterian Morgan Stanley Children s Hospital Ana Lucia Associate Professor of Clinical Pediatrics and Orthopaedic Surgery mgv1@columbia.edu