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Musculoskeletal Education and Research Center Symposium \nGuest Editor: K. Daniel Riew, MD\n\nStart reading this special issue to learn more on the advancements in the surgical treatment of spinal disorders. Prominent spine surgeons and researchers from the 2016 Annual Musculoskeletal Education and Research Center Symposium give you insights on the latest techniques in spinal surgery, and provide you with in-depth basic science topics, such as biomechanics and biologics sharing their expertise and challenges. \n

Published April 1, 2017

Read the recent research from the Second Annual Musculoskeletal Education and Research Center Symposium, held last August. The Symposium hosted several keynote speakers, including Dr. Hans-Joachim Wilke and Professor Wolfgang Rauschning. Dr. Wilke emphasized the importance of clinicians and basic scientists working together to develop new technologies. Dr. Rauschning utilized his novel cryotome technique and photographic imagery to display relevant surgical anatomy. Several biomechanical engineering scholars, including Dr.Vijay Goel and Dr. Lisa Ferrera, highlighted the role of computational modeling and mechanical testing in establishing standards in the design and evaluation of spinal devices. Dr. Nadim Hallab, an immunologist of musculoskeletal tissue, reported on the host response to implants.

Clinical aspects of the Symposium focused primarily on deformity, especially in the sagittal plane. As a reader you can access the discussions of how to measure deformity and the role of pelvic alignment. Learn about treatment options included osteotomy and lateral approaches, and discussions on the role of biologics and the promise of navigation. Enjoy the debate on the role of rigidity in fixation (rigid vs. semi-rigid).

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Published April 2016

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Problem/Condition: Spina bifida is a birth defect of the spinal column thatis a substantial contributor to serious developmental disabilities in theUnited States. The risk for spina bifida and other neural tube defects(NTDs) can be reduced if women consume 0.4 mg of folic acid before andduring the first trimester of pregnancy. Public health programs are beingdeveloped to prevent many NTDs by increasing the consumption of folic acidby women of childbearing age. To assess the national impact of theseprograms on the prevalence of NTDs at birth, multistate surveillance isneeded to monitor secular trends in birth-prevalence rates. This reportsummarizes a collaborative effort by CDC and state birth defectsurveillance programs in 16 states to a) obtain multistate, population-based data concerning the birth prevalence and descriptive epidemiology ofspina bifida and b) determine the usefulness of combining statesurveillance data to monitor national trends in the birth prevalence ofNTDs.

Description of Systems: Population-based data about live-born and stillborninfants who have spina bifida were analyzed from 16 state programs. **These 16 programs differed in size and racial/ethnic composition of thepopulations, surveillance methods, and completeness of case ascertainment.Hospital-based data about live-born and stillborn infants who have spinabifida also were analyzed from BDMP, a passive case ascertainmentsurveillance system that obtains data from participating hospitals in 50states.

Results and Interpretation: From 1983 through 1990, the birth-prevalencerate for spina bifida for the 16 states was 4.6 cases per 10,000 births;the BDMP rate was nearly identical (4.4 cases). State-specific rates variedsubstantially, ranging from 3.0 (Washington) to 7.8 (Arkansas). Both state-based and BDMP rates varied among racial/ethnic groups; in both systems,the rates were highest for Hispanics and lowest for Asians/PacificIslanders. In both the state-based surveillance systems and BDMP, theannual rate of spina bifida for the total population declined during theperiod 1983-1990. Much of this decline can be attributed to increasedprenatal diagnosis in the 1980s. However, because the decline in the ratesof spina bifida and other NTDs in the United States began before thewidespread availability of prenatal diagnostic services, an environmentalcomponent may have contributed substantially to the etiologies of thesedefects. The birth-prevalence rate of spina bifida was slightly higheramong females than males. The ratio of female-to-male prevalence rates was1.2 for both the state-based surveillance systems and BDMP. This ratiovaried considerably among racial/ethnic groups and among states. Thesimilarities of rates and trends in the birth prevalence of spina bifidabetween the state-based surveillance data and the BDMP data indicate thatboth types of surveillance systems can provide reliable informationconcerning national trends in the birth prevalence of spina bifida.

Actions Taken: CDC and state birth defects surveillance programs will useresults from this analysis to monitor national trends in the birthprevalence of spina bifida in the United States. Aggregated state-basedsurveillance data about spina bifida, anencephaly, and other NTDs willfacilitate the monitoring of changes in NTDs after implementation ofprograms to increase folic acid consumption by women of child-bearing age.

Spina bifida, a birth defect of the spinal column that causes varyingdegrees of paralysis, is a major contributor to serious developmentaldisabilities in the United States. The public health impact of thisdisability is substantial. Each year, approximately 1,500 infants are bornwith spina bifida (1). The annual medical and surgical costs (based on 1985dollars) for persons who have spina bifida exceed $200 million (1), and thelifetime cost to society per person who has spina bifida is estimated to be$258,000 greater than the cost for persons who are unaffected by thisdisability (in 1988 dollars) (2). Dietary supplementation with folic acid(a B vitamin) reduces the risk for spina bifida and other neural tubedefects (NTDs) (3). In 1992, the Public Health Service (PHS) published arecommendation that all women of childbearing age who are capable ofbecoming pregnant should consume 0.4 mg of folic acid per day to reduce therisk for having a pregnancy affected by spina bifida or other NTDs (3). PHSestimates that if all women in the United States followed thisrecommendation, the annual number of cases of spina bifida and other NTDswould decrease by 50% (3).

Multistate surveillance of birth-prevalence rates is required to assessthe national impact of public health programs to reduce the prevalence ofNTDs by dietary supplementation with folic acid. Until recently, the onlysource of ongoing information about the national birth prevalence of spinabifida and other NTDs was CDC's Birth Defects Monitoring Program (BDMP), ahospital-based surveillance system that obtains information about birthdefects among newborns from discharge abstracts submitted by participatinghospitals (4). However, in the past decade, several states have establishedpopulation-based birth defect surveillance systems that collect dataregarding spina bifida and other serious birth defects. In this report, CDChas analyzed data from 16 states that maintain birth defects surveillancesystems to obtain multistate, population-based data regarding the birthprevalence and descriptive epidemiology of spina bifida. This reportexpands the analysis of previously published state-based data for 1983-1990(5) and compares the results with BDMP data for the same period to assesstrends.

The participating states provided surveillance data regarding spinabifida for the period 1983-1990; however, not all states had data for theentire period. All live-born and stillborn infants who had spina bifida ***were included in the analysis; however, in three states, data were notavailable for cases involving stillborn infants. Nine state surveillancesystems (i.e., Colorado, Illinois, Maryland, Missouri, Nebraska, NewJersey, New York, North Carolina, and Virginia) identified cases of spinabifida from reports submitted by physicians and the staff of hospitals,clinics, and other health-care facilities (i.e., passive caseascertainment). Seven states (i.e., Arizona, Arkansas, California, Georgia,Hawaii, Iowa, and Washington) used trained surveillance staff to identifycases of spina bifida by systematic review of medical and other recordsfrom hospitals, clinics, and other health-care facilities (i.e., activecase ascertainment). Birth-prevalence rates for spina bifida weredetermined for each state during the surveillance period. However, thespecific surveillance periods covered from 1983 through 1990 varied bystate (Table_1). BDMP rates for spina bifida in the United States forthis period also were determined for comparison with state data.

Because prevalence rates have differed previously between certainracial and ethnic groups, data were collected by race/ethnicity (i.e.,white, black, Asian, **** American Indian, ***** and Hispanic) in both thestate-based surveillance systems and BDMP. State-based surveillance systemsprimarily determined race/ethnicity from birth certificates, whereas BDMPdetermined race/ethnicity from hospital discharge summaries. Chi-squaretests were used to compare differences between racial and ethnic groups inspina bifida rates and female-to-male rate ratios. To determine temporaltrends in spina bifida rates and female-to-male rate ratios, a linearregression analysis was performed on the logarithms of the annual rates andrate ratios.

The participating states were grouped into the four U.S. censusregions: Northeast, North Central, South, and West (Table_1). From 1983through 1990, the birth-prevalence rate of spina bifida for these 16 stateswas 4.6 cases per 10,000 births. The rate of spina bifida determined byBDMP was nearly identical (4.4 cases). Although rates were similar byregion, state-specific rates varied substantially, ranging from 3.0(Washington) to 7.8 (Arkansas). be457b7860