Hip and Spine Surgery is of Questionable Value in Spina Bifida: An Evidence-based Review
Why this work is in the frame
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Bibliographic record
Abstract
BACKGROUND: Although many children with spina bifida and associated scoliosis or dislocated hips undergo spine or hip surgery, the benefits are uncertain. QUESTIONS/PURPOSES: The purpose was to perform an evidence-based review on the benefits and risks of surgery for dislocated hips and scoliosis in spina bifida. METHODS: I performed a Medline(®) and Embase(®) search from 1950 to 2009 for Level I to Level III studies investigating the benefits and risks of surgery for scoliosis and hip dislocation in patients with spina bifida. When available, I extracted types of surgery, complication rates, functional outcomes of seating, walking, and overall physical function. All treatment recommendations received a Grade of Recommendation: Grade A (consistent Level I studies); Grade B (consistent Level II and III studies); Grade C (consistent level IV and V studies); or Grade I (insufficient or contradictory studies). RESULTS: Combined anterior and posterior surgery had lower rates of nonunion for scoliosis. Although there may be some benefit in seating, overall physical function measured in a different and nonstandardized fashion was not much changed and major complication rates, including nonunion and infections for scoliosis surgery, exceed 50% in several studies. For dislocated hips, the impact on walking ability appears related to contracture (not dislocation). Surgery for hip dislocation did not improve walking ability. The literature provides no guidance on the best treatment for unilateral dislocation. CONCLUSIONS: The benefits of scoliosis surgery are uncertain (Grade I). Spine surgery, if performed, should be anterior and posterior (Grade B). An all-pedicle approach for scoliosis surgery may be effective (Level I). Hip reduction surgery did not improve walking (Grade B) but may be appropriate in low-level unilateral dislocation (Level I).
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Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.016 | 0.010 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.003 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.004 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it