Advanced Scoliosis Research Articles

Navigation-guided endoscopic lumbar decompression on foramen and lateral recess in advanced scoliosis.

An 84-year-old woman presented with left leg radiating pain for 18 months and a numeric rating scale score of 8. From examination, motoric on left knee extension was grade 4, with dysesthesia and numbness along the left anterolateral thigh. Imaging showed left L3-4 foraminal and lateral recess stenosis with severe-degree scoliosis. The patient underwent navigation-guided endoscopic transforaminal foraminotomy and lateral recess decompression on the left L3-4 level with a good outcome. Three-years' follow-up showed a well-maintained clinical outcome and coronal sagittal balance. This video explores navigation-guided endoscopic lumbar decompression for neural compression in advanced scoliosis. Further research is encouraged to establish long-term efficacy. The video can be found here: https://stream.cadmore.media/r10.3171/2024.1.FOCVID23195.

The usefulness of the open surgical technique of sternocostal elevation for asymmetric pectus excavatum: a retrospective study.

The Nuss procedure is currently the mainstream of pectus excavatum (PE) surgery; however, it is considered to be more difficult for asymmetric cases than for symmetric ones. Sternocostal elevation (SCE), which was performed at our hospital, is a surgical method that determines the extent of resection of the costal cartilage while comparing the left and right balance during surgery; thus, it is highly useful for correcting rib cage with strong asymmetry. Of the 256 patients who underwent SCE at our hospital between July 2014 and July 2022, 58 (22.7%) with asymmetric PE were retrospectively examined. However, patients with advanced scoliosis having a Cobb angle of 25° or higher were excluded; therefore, 51 (19.9%) patients were analyzed. Two indices and other measurements were evaluated to determine the success of correction for asymmetry using computed tomography (CT). The difference between the left and right thoraxes, the Haller index, and the sternal torsion angle significantly improved. Furthermore, we herein set a new numerical index as an indicator of asymmetry improvement and to be used for a more standard thorax morphology; the difference between the left and right thoraxes/the average of the left and right thoraxes. That new index also significantly improved. SCE is considered a highly useful surgical method for asymmetric PE.

Retrograde intrarenal surgery for impacted upper ureteral stone in a patient with advanced lumbar scoliosis and lower-extremity development defect: a case report

BackgroundToday, retrograde intrarenal surgery is the most preferred and very successful treatment method for upper ureteral stones that do not spontaneously pass and/or do not benefit from extracorporeal wave lithotripsy. However, perioperative complications are more common in retrograde intrarenal surgery if the stone in the ureter is impacted. Moreover, urosepsis and renal dysfunction are detected more frequently in patients with impacted stones. Impacted stones, which are a risky stone group even in patients with normal vertebral anatomy, are a more challenging situation in patients with advanced vertebral scoliosis. It is difficult to achieve an operating position in these patients. In addition, the ureteral tracing is altered, curved, and tortuous, making it more difficult for the endoscope to advance through the ureter.Case presentationIn this case report, we present a 23-year-old Caucasian male patient with right concavity and severe scoliosis, lower-extremity developmental disorder, and urosepsis. To treat the urosepsis picture, first percutaneous nephrostomy drainage was provided and the urine was sterilized with appropriate antibiotics according to the culture/antibiogram. Then, we performed ureterolithotripsy with a flexureterorenoscope. Finally, we see that flexible ureterorenoscopic lithotripsy to the upper ureteral stone with impacted stones, which is a very challenging operation even in patients with normal vertebrae, could be successfully performed in our patient with advanced scoliosis deformity.ConclusionHigh stone-free and low complication rates can be obtained with flexible ureterorenoscopic retrograde intrarenal surgery in medium-sized impacted upper ureteral stones in patients with advanced scoliosis.

Reduced bone mineral density in adolescents with Duchenne Muscular Dystrophy (DMD) and scoliosis

SummaryDuchenne muscular dystrophy is a progressive disease usually associated with loss of ambulation and progressive scoliosis. Immobilisation and glucocorticoid treatment are predisposing factors for reduced bone mineral density (BMD). Analysis of quantitative computed tomography revealed low BMD in thoracic and lumbar vertebrae in comparison to age- and sex-matched healthy controls.IntroductionEvaluation of vertebral bone mineral density (BMD) in Duchenne Muscular Dystrophy (DMD) adolescents with untreated advanced scoliosis and comparison with the BMD values of healthy age-matched controls, based on quantitative computer tomography.MethodsThirty-seven DMD adolescents (age 15.6 ± 2.5 years) with spinal deformity were evaluated clinically and radiologically prior to definite spinal fusion and compared to 31 male and age-matched healthy individuals (age 15.7 ± 2.3 years). Data related to previous medical treatment, physiotherapy and ambulatory status was also analysed. Scoliotic curves were measured on plain sitting radiographs of the spine. The BMD Z-scores of the thoracic and lumbar vertebrae were calculated with QCTpro® (Mindways Software Inc., USA), based on data sets of preoperative, phantom pre-calibrated spinal computed tomography scans.ResultsA statistically significant lower BMD could be found in DMD adolescents, when compared to healthy controls, showing an average value for the lumbar spine of 80.5 ± 30.5 mg/cm3. Z-scores deteriorated from the upper thoracic towards the lower lumbar vertebrae. All but the uppermost thoracic vertebrae had reduced BMD values, with the thoracolumbar and lumbar region demonstrating the lowest BMD. No significant correlation was observed between BMD and the severity of the scoliotic curve, previous glucocorticoid treatment, cardiovascular impairment, vitamin D supplementation, non-invasive ventilation or physiotherapy.ConclusionDMD adolescents with scoliosis have strongly reduced BMD Z-scores, especially in the lumbar spine in comparison to healthy controls. These findings support the implementation of a standardised screening and treatment protocol.Level of evidence/clinical relevance: therapeutic level III

Hemoptysis due to progressive scoliosis associated with congenital heart disease: a case report

BackgroundPatients with congenital heart disease (CHD) are associated with an increased incidence of scoliosis, often with severe progression. We report a case of hemoptysis caused by rapid scoliosis progression subsequent to surgery for CHD that was successfully managed by surgical curve correction following coil embolization.Case presentationA 14-year-old girl with scoliosis had undergone open heart surgery for CHD at the age of 1 year. She was first noted to have scoliosis at 12 years of age, which began to progress rapidly. At age 13, her main thoracic curve Cobb angle was 46°, and hemoptysis with high pulmonary vein pressure due to vertebral rotation was detected. Nine months after coil embolization, she received posterior spinal fusion from T5 to L2 for scoliosis correction. Postoperatively, her pulmonary vein diameter was enlarged, with no detectable signs of hemoptysis.ConclusionsWe encountered a case of hemoptysis caused by advanced scoliosis after cardiac surgery that was successfully treated by correction of the scoliotic curve following coil embolization. Patients with secondary scoliosis after surgery for CHD should be carefully monitored for the possibility of cardiovascular system deterioration.

Efficacy of X-ray fluoroscopic-guided lumbar puncture for spinal muscular atrophy with advanced scoliosis: two case reports

Efficacy of X-ray fluoroscopic-guided lumbar puncture for spinal muscular atrophy with advanced scoliosis: two case reports

Caudal Anesthesia for Open Bladder Surgery in High-Risk Adolescent With Scoliosis and Neural Tube Defect.

Caudal Anesthesia for Open Bladder Surgery in High-Risk Adolescent With Scoliosis and Neural Tube Defect.

Investigation of the retrorenal colon frequency using computed tomography in patients with advanced scoliosis

The aim of this study is to investigate the frequency of retrorenal colon in patients with advanced scoliosis. The existence of retrorenal colon was retrospectively investigated in 550 patients with vertebral scoliosis who had undergone abdominal CT scans at our institution between January 2008 and March 2012. The investigation was also carried out on a control group of 200 patients without scoliosis. Among the 550 patients with scoliosis, 100 patients had advanced scoliosis necessitating treatment. Among these 100 patients with advanced scoliosis, retrorenal colon was detected in a total of 25 patients (25%). The variation was observed on the right side in eight patients (two males, six females) (8%), on the left side in 15 patients (five males, ten females) (15%), and bilaterally in two patients (both females) (2%). In the control group consisting of 200 individuals, retrorenal colon was detected in seven subjects (3.5%), among which six were on the left and one was on the right. The difference between the incidence of retrorenal colon observed in the patients with advanced scoliosis and those without scoliosis was found to be statistically significant (p<0.001). Since the frequency of retrorenal colon in patients with advanced scoliosis is significantly higher than the control group without scoliosis, the risk of experiencing complications during renal interventions including renal biopsy is also higher. Therefore, these patients should undergo a detailed CT examination before these procedures, and renal interventions should be planned according to findings.

The Importance of a Percutaneous Trial of a Spinal Cord Stimulator in a Patient with Extreme Scoliosis

To the Editor, As a technique that relies on anatomical landmarks, percutaneous placement of a spinal cord stimulator (SCS) can be very difficult in patients with scoliosis. This is due not only to the abnormal anatomy of patients with scoliosis, but also to the postoperative changes that occur as a result of corrective procedures. Because of this, surgical placement is often opted for over percutaneous placement. As current literature supports only about a 50–60% success rate in treatment of patients with failed back surgery syndrome (FBBS) [1], we feel that a percutaneous trial placement is a more conservative and subsequently superior modality compared with undergoing surgical placement without trial. A literature search revealed only one case report of percutaneous placement with a case of advanced scoliosis [2]. We present another successful placement and hope to encourage other practitioners to consider a minimally invasive trial prior to scheduling a patient for operative placement. Percutaneous SCS placement has been shown to be a cost-effective technique and is minimally invasive [1,3]. Procedure-related discomfort that may compromise a therapeutic trial is also minimized. Percutaneous electrodes allow longitudinal access to multiple levels via a single interlaminar needle puncture. This facilitates mapping of multiple targets. The use of …

Pulmonary Compensatory Indexes in Children and Adolescents With Grade II and III Idiopathic Scoliosis

Spirometric and pletysmographic examinations were performed in two groups of children, Group I, 39 children: 32 girls and 7 boys at the age of 12-19 years (the mean age was 14.67 ′ 1.47 yr) with grade II and III scoliosis, the angle of curvature 63.35 ′ 17.07 degree. The children were patients of the Department of Orthopaedics of the Silesian Medical Academy. The Control Group were 20 children, 13 girls and 7 boys at the age of 8-16 (the mean age was 13.77 ′ 1.72 yr). The measurements were done using Body - pletysmograph with pneumotachograph Jaeger. Total lung capacity (TLC), forced vital capacity (FVC), forced expiratory volume in 1 sec. (FEV1), residual volume (RV), intrathoracal gas volume (ITGV) and at the same time curve indexes, dependence of maximum expiratory flow lung volume, MEF75%VC, MEF50%VC, MEF25%VC were determined. Maximum expiratory flows in relation to vital capacity and total lung capacity were defined as so-called compensatory indexes, were also calculated. A statistically significant decrease of MEF25%VC/TLC index was observed in children with advanced scoliosis in comparison to the control group of children (p < 0.001). A statistically significant reduction of MEF50%VC/TLC in children with grade II and III scoliosis was shown in comparison to healthy children (p < 0.002), and MEF50%VC/FVC was statistically significantly decreased in comparison to the control group (p < 0.001).

Structural vertebral changes in the horizontal plane in idiopathic scoliosis and the long-term corrective effect of spine instrumentation.

The rotation and structural changes of the apex vertebra in the horizontal plane as well as of the thoracic cage deformity were quantified by measurements on computed tomography (CT) scans from patients with right convex thoracic idiopathic scoliosis (IS). The CT scans were obtained from 12 patients with moderate scoliosis (mean Cobb angle 25.8 degrees, r 13 degrees-30 degrees) and from 33 with severe scoliosis (mean Cobb angle 46.2 degrees, r 35 degrees-71 degrees). In addition, CT scans of thoracic vertebrae from 15 patients without scoliosis were used as reference material. Ten of the scoliotic cases had had Cotrel-Dubousset instrumentation (CDI) and posterior fusion and had entered a longitudinal study on the effect of operative correction on the re-modelling of the apical vertebra. An increasingly asymmetrical vertebral body, transverse process angle, pedicle width and canal width were found in the groups with scoliosis as compared with the reference material. Vertebral rotation and rib hump index were significantly larger in patients with early and advanced scoliosis than in normal subjects. The modelling angle of the vertebral body, the transverse process angle index and the vertebral rotation in relation to the middle axis of the thoracic cage were significantly greater in patients with severe than with moderate scoliosis. The results of this longitudinal study suggest that the structural changes of the apical vertebra regress 2 years or more after CD instrumentation.