Incidence Of Spinal Deformity Research Articles

Long term outcome of Selective Dorsal Rhizotomy for the management of childhood spasticity-functional improvement and complications.

Selective dorsal rhizotomy (SDR) for the management of lower extremity spasticity is a surgical technique that has existed since the 1900s. While much evidence supports its efficaciousness in reducing tone in the short term, limited information exists detailing the long-term outcome and evolution over time of patients undergoing SDR. All publications with 10years or more of outcome data on patients undergoing SDR were identified from Medline and Embase databases using the search term "Rhizotmy." Only publications that were in English included patients with cerebral palsy under the age of 21 and discussed SDR for lower extremity spasticity were included. Case reports, reviews without primary data, or publications not accessible online were excluded from the review. A total of 2128 publications were initially identified, of which 19 papers describing 1054 patients fit inclusion and exclusion criteria. GMFCS in most patients improved or remained stable over time after surgery, although durability of improvement and final outcome was dependent on initial functional status. Tone was noted to also substantially improve although a small proportion required additional oral or injectable pharmacologic agents and an even smaller proportion required baclofen pumps. Upper extremity function was also noted to improve substantially after SDR. A significant number of patients were independent for activities of daily living and were engaged in secondary education or gainful employment. A significant proportion of patients still required orthopedic surgery to the lower extremities after SDR, although the incidence of spinal deformity was not observed to be substantially elevated over that of natural history. SDR offers substantial improvements to a number of domains beyond pure tone reduction. These changes are durable over time, although patient selection is crucial in identifying those patients that will have the most benefit. Long-term follow-up is in important in this population given the potential need for further interventions that still exist in many patients.

Evaluation of Practical Diets for Juvenile Lost River Suckers

AbstractA 9‐week feeding trial was conducted to evaluate one custom formulation and six commercially available diets when fed to juveniles of the endangered Lost River Sucker Deltistes luxatus. The seven treatments included the following: two catfish Ictalurus spp. diets, a tilapia Oreochromis spp. diet, a shrimp diet, a general warmwater fish diet, a general fish diet, and a feed formulated at the Abernathy Fish Technology Center (Abernathy sucker diet). The general fish diet produced fish that were significantly larger than the fish fed the other diets. The Lost River Suckers fed the general fish diet or the Abernathy sucker diet averaged 99.0% survival for the duration of the trial, which was significantly higher than in Lost River Suckers fed all other diets except for one catfish diet. Spinal deformities were significantly less frequent in fish fed the general fish diet and the Abernathy sucker diet. Whole‐body proximate and fatty acid composition were affected by diet. Whole‐body fatty acid profiles generally mirrored the diet profiles. The general fish diet appears to be an effective diet for juvenile Lost River Suckers, although the Abernathy sucker diet should be considered for further development as it yielded high survival and no incidence of spinal deformity.

The incidence of spinal deformity in individuals who care for children with physical disabilities

The incidence of spinal deformity in individuals who care for children with physical disabilities

Incidence and the risk factors of spinal deformity in adult patient after spinal cord injury: a single center cohort study.

A retrospective consecutive case series of adult spinal cord injuries (SCIs) patients. To assess the incidence and risk factors of spinal deformity in a large sample of patients with SCIs. Post-traumatic spinal deformities are well-recognized sequelae of SCIs. Despite the devastating complications for SCI patients with trunk imbalance, the incidence, clinical outcomes, and independent risk factors of scoliosis after SCI remain controversial. We assessed 214 consecutive adult compressive SCI patients who were hospitalized in our hospital. We compared patients who developed spinal deformities with those who did not. Univariate and multivariate analyses to determine the independent risk factors were performed. Age, gender, etiology, ASIA grade (American Spinal Injury Association) surgery, and other demographic data were analyzed to determine the risk factors for developing a spinal deformity. The average patient age was 58.3 years (20-86 years). The etiology was trauma (n = 158), ossification of ligament (n = 22), infectious (n = 17), and others. One hundred fifty-two patients had cervical spine involved, 62 had thoracic spine involved. 26 patients classified as ASIA A, 54 were ASIA B, 96 were ASIA C, and 42 were ASIA D 4. One hundred thirty-five patients had either decompression or decompression and fusion surgery. The incidence of spinal deformities was 21 % (44/214). The mean Cobb angle was 28.9 degrees (13-38°). ASIA grade and surgery predicted the occurrence of spinal deformity in both the univariate model (ASIA grade, OR: 1.59 [95 % CI: 1.04-2.44; P = 0.032]; Surgery, OR: 4.47 [95 % CI: 1.89-10.06; P = 0.0007]) and the multivariate model (ASIA grade, OR: 1.63 [95 % CI: 1.04-2.57; P = 0.033]; Surgery, OR: 4.59 [95 % CI: 1.91-11.04; P = 0.0006]), whereas surgery was the most important risk factor in the Cox model (HR: 3.50 [95 % CI: 1.56-7.88; P = 0.0025]). The SCI patients with high ASIA grades and those who had undergone surgery had a higher likelihood of developing a spinal deformity. Of these risk factors, surgery was the stronger risk factor.

Treatment of scoliosis in patients affected with Prader-Willi syndrome using various techniques

BackgroundThe incidence of spinal deformity in children with Prader-Willi syndrome (PWS) is high, with 86% of these patients found to have a significant structural scoliosis; however, there are very few case reports describing surgical treatment for this deformity.MethodsThe authors reviewed a case series consisting of 6 patients who underwent spine surgery for scoliosis. Children's mean age at index surgery was 12 years and 10 months (range, 10 to 15 yrs). Clinical evaluation revealed the typical phenotypic features of the PWS in all of the patients; 4 subjects had a karyotype confirmation of PWS. Major structural curves showed preoperative mean Cobb angles of 80.8° (range, 65° to 96°). Hybrid instrumentation with sublaminar wires, hooks and screws was used in the first 2 patients, while the remaining 4 were treated with titanium pedicle screw constructs.ResultsThe mean clinical and radiological follow-up was 3 years and 10 months (range, 2 years to 9 years). Major complication rate was 50%. One patient who developed a major intraoperative complication (paraparesis) prevented spinal fusion to be obtained: the neurologic deficit resolved completely after instrumentation removal. Solid arthrodesis and deformity correction in both coronal and sagittal plane was, however, achieved in the other 5 cases and no significant curve progression was observed at follow-up. Another major short-term complication was encountered 3 months after surgery in a patient who experienced the detachment of a distally located rod and required correction through revision surgery and caudal extension by one level. Cervico-thoracic kyphosis was seen in 1 patient who did not require revision surgery.ConclusionsSpine reconstructive surgery in patients with PWS is rare and highly demanding.The best method of reconstruction is posterior multilevel pedicle screw fixation. Moreover, even with modern techniques, the risk of complications is still high. These new techniques, however, have shown to improve the postoperative course by allowing for immediate mobilization without any brace or cast. The use of the growing rod techniques, requiring repeated surgeries, should be carefully evaluated in each single case.

Incidence of spinal deformity after resection of intramedullary spinal cord tumors in children who underwent laminectomy compared with laminoplasty

Incidence of spinal deformity after resection of intramedullary spinal cord tumors in children who underwent laminectomy compared with laminoplasty

Incidence of spinal deformity after resection of intramedullary spinal cord tumors in children who underwent laminectomy compared with laminoplasty

Gross-total resection of pediatric intramedullary spinal cord tumor (IMSCT) can be achieved in the majority of cases while preserving long-term neurological function. Nevertheless, postoperative progressive spinal deformity often complicates functional outcome years after surgery. The authors set out to determine whether laminoplasty in comparison with laminectomy has reduced the incidence of subsequent spinal deformity requiring fusion after IMSCT resection at their institution. The first 144 consecutive patients undergoing resection of IMSCTs at a single institution underwent laminectomy with preservation of facet joints. The next 20 consecutive patients presenting for resection of IMSCTs underwent osteoplastic laminotomy regardless of patient or tumor characteristics. All patients were followed up with telephone interviews corroborated by medical records for the following outcomes: 1) neurological and functional status (modified McCormick Scale [MMS] score and Karnofsky Performance Scale [KPS] score); and 2) development of progressive spinal deformity requiring fusion. The incidence of progressive spinal deformity and the long-term neurological function were compared between the laminectomy and osteoplastic laminotomy cohorts. The means are expressed +/- the standard deviation. Overall, the patients' mean age was 8.6 +/- 5 years, and they presented with median MMS scores of 2 (interquartile range [IQR] 2-4). A > 95% resection was achieved in 125 cases (76%). There were no differences (p > 0.10) between patients treated with osteoplastic laminotomy and those treated with laminectomy in terms of the following characteristics: age; sex; duration of symptoms; location of tumor; incidence of preoperative scoliosis (Cobb angle > 10 degrees : 7 [35%] with laminoplasty compared with 49 [34%] with laminectomy); involvement of the cervicothoracic junction (7 [35%] compared with 57 [40%]); thoracolumbar junction (4 [20%] compared with 36 [25%]); tumor size; extent of resection; radiation therapy; histopathological findings; or mean operative spinal levels (7.5 +/- 2 compared with 7.5 +/- 3). Nevertheless, patients who underwent osteoplastic laminotomy had better median preoperative MMS scores than those treated with laminectomy (2 [IQR 2-2] compared with 2 [IQR 2-4]; p = 0.04). A median of 3.5 years (IQR 1-7 years) after surgery, only 1 patient (5%) in the osteoplastic laminotomy cohort required fusion for progressive spinal deformity, compared with 43 (30%) in the laminectomy cohort (p = 0.027). Adjusting for the inter-cohort difference in preoperative MMS scores, osteoplastic laminotomy was associated with a 7-fold reduction in the odds of subsequent fusion for progressive spinal deformity (odds ratio 0.13, 95% confidence interval 0.02-1.00; p = 0.05). The median MMS and KPS scores were similar between patients who underwent osteoplastic laminotomy and those in whom laminectomy was performed (MMS Score 2 [IQR 2-3] for laminotomy compared with 2 [IQR 2-4] for laminectomy, p = 0.54; KPS Score 90 [IQR 70-100] for laminotomy compared with 90 [IQR 80-90] for laminectomy, p = 0.545) at a median of 3.5 years after surgery. In the authors' experience, osteoplastic laminotomy for the resection of IMSCT in children was associated with a decreased incidence of progressive spinal deformity requiring fusion but did not affect long-term functional outcome. Laminoplasty used for pediatric IMSCT resection may decrease the incidence of progressive spinal deformity requiring subsequent spinal stabilization in some patients.

Spinal Deformity Secondary to Impaired Neurologic Control

Spinal deformity occurs in children who have problems with motor control involving the trunk muscles. This lack of control allows the growing spine to collapse. Most commonly, this collapse is due to spasticity in children with the quadriplegic pattern of cerebral palsy. The most typical collapse pattern is scoliosis, although kyphosis or lordosis may also develop. Children who have severe hypotonia may also have development of spinal deformities, often with substantial kyphosis. Individuals with severe extensor posturing may have development of total spinal lordosis. A severe lack of motor control, expressed as a movement disorder such as athetosis or dystonia, is associated with a lower incidence of scoliosis than spasticity is. The incidence of scoliosis in institutionalized individuals, most of whom have a spastic quadriplegic pattern, has been reported to be 64%, with a strong inverse relationship to ambulatory ability1. This means that individuals who are dependent sitters with no head control may have a rate of scoliosis as high as 90%. We are not aware of published data on the incidence of spinal deformity with other movement disorders. Friedreich ataxia is a condition in which the primary neurologic manifestation is also a lack of motor control and in which the development of spinal deformities, primarily scoliosis, is common. Progressive scoliosis requiring surgical stabilization develops in approximately 50% of these individuals2. Individuals with motor-control problems tend to have development of spinal deformity in late childhood. Initially, the child often has very flexible postural curves and tends to lean toward one side. Typically, as the child enters early adolescent growth, the spine develops a structural torsional deformity with increasing stiffness. This structural curve may become so stiff that physical correction, even when the child is in a lying position, is impossible. The stiffness typically increases as the …

Spontaneous spinal epidural hematoma in a toddler—a case report

Spontaneous spinal epidural hematoma (SSEDH) is rare in children below the age of 2 years. It can produce rapidly progressive neurological deficits. The authors report a case of SSEDH in a 15-month-old boy diagnosed by MRI. Suspension laminotomy and evacuation of the clot were done 48 h after the onset of symptoms. The patient made excellent neurological recovery. Computed tomography (CT) and MRI scanning carried out 6 months after surgery revealed good fusion of the laminotomy. A brief review of relevant literature is presented. Although rare SSEDH requires immediate surgical decompression to avoid any permanent neurological deficit. Reconstructive surgical procedures like laminotomy are preferred in children where the incidence of spinal deformity is high following laminectomy.

Incidence of spinal deformity in children after multiple level laminectomy for selective posterior rhizotomy

Fifty-five children with cerebral palsy had multiple-level laminectomies for selective posterior rhizotomies for the relief of spasticity. They were followed up clinically and radiologically to assess their spinal stability and the possible development of post-laminectomy deformity of the spine. The majority of the deformities found were related to cerebral palsy and did not appear to be due to the laminectomy: 16% had scoliosis, 5% kyphosis, 7% lordosis, and 9% spondylolysis/spondylolisthesis. Spondylolysis is the only abnormality that appeared to be more common in this group than in children with cerebral palsy.

An Unusally High Incidence of Spinal Deformity among Threadfin Shad

An Unusally High Incidence of Spinal Deformity among Threadfin Shad