Kyphoscoliotic Patients Research Articles

Anesthetic management of a Kyphoscoliotic parturient with Mitral valve prolapse posted for emergency cesarean section

Kyphoscoliosis is a spinal deformity with forward and lateral deviation of the normal spine. It occurs in up to 4% of the population. This condition in pregnancy causes altered growth of gravid uterus and leads to unpredictable delivery. These deformities if extreme can cause obstructed labor which will require cesarean section and are usually associated with physiologic derangements in cardiopulmonary function causing difficulties in conducting both general and regional anaesthesia. One of the causes of kyphoscoliosis can be secondary to cardiothoracic surgery in the childhood. Subarachnoid block in kyphoscoliotic patients is always challenging to an anesthesiologist due to the deformity of spine and spread of anesthetic drug to unpredicted level. We present a known case of post cardiac surgery, mitral valve prolapse with kyphoscoliosis in the thoracolumbar region posted for emergency cesarean section managed under subarachnoid blockade.

Administration of Spinal Anaesthesia with Modified Paramedian Technique in a Patient with Kyphoscoliosis: A Case Report

Kyphoscoliosis is a condition that affects the spine, with adolescents accounting for 75-90% of cases of idiopathic scoliosis. Scoliosis patients may experience difficulties when receiving anaesthesia during surgical procedures. There is often multisystem involvement, including the cardiovascular, nervous, and respiratory systems. Patients who have scoliosis often have difficulties with their airways (affected airway morphology, difficult intubation with laryngoscopy), respiratory systems (hypoxia, alveolar vascular constriction, pulmonary hypertension), and cardiac systems (cardiomyopathy, right ventricular enlargement, but also cor pulmonale). Scoliosis can bring on a restrictive pulmonary disease, which can lead to a decrease in both total lung volume and functional residual capacity, as well as an increase in breathing rate. Owing to the deformities of the vertebra, subarachnoid blocks in patients with kyphoscoliosis generally constitute a special hurdle for the anaesthesiologist. Midline and paramedian approach for spinal anaesthesia has been practiced since long but a novel approach as modified paramedian technique allows the entry of the needle from far away from midline hence reducing the number of punctures taken and lesser complications. Respiratory and airway concerns are customarily addressed in kyphoscoliotic patients. Authors present a unique case of 35-year-old male with severe kyphoscoliosis with neurofibromatosis posted for right above knee amputation by spinal anaesthesia using modified paramedian technique. Authors planned for subarachnoid block for this patient with modified paramedian approach which resulted in right-sided dense block with patchy sensory and motor block on left-side. For a successful operation, scoliosis patients require a thorough preoperative evaluation, a well-equipped set-up, and a teamwork.

Anesthetic management of parturient with thoracic kyphoscoliosis, malaria and acute respiratory distress syndrome for urgent cesarean section

The management of cesarean section in kyphoscoliotic patient is challenging. The respiratory changes and increased metabolic demands due to pregnancy may compromise the limited respiratory reserves in such patients. Presence of other comorbidities like malaria and respiratory tract infection will further compromise the effective oxygenation. We report a case of kyphoscoliosis along with malaria and acute respiratory distress syndrome for urgent cesarean section.

Percutaneous Intervention in Kyphoscoliosis—Tackling a Tortuosity*

Spine deformities have several associations with compromised cardiorespiratory function. Percutaneous coronary interventions rely on fluoroscopic anatomical landmarks to guide procedures, and distortion of the mediastinal soft tissue and skeletal anatomy in conditions like kyphoscoliosis can pose unique challenges for the interventional cardiologist. Here, we report a case of elderly kyphoscoliotic male patient with worsening angina, who underwent successful percutaneous coronary intervention via the radial route.

Efficacy of noninvasive volume targeted ventilation in patients with chronic respiratory failure due to kyphoscoliosis.

Severe kyphoscoliosis can cause chronic respiratory failure. Noninvasive mechanical ventilation (NIMV) is a new optional treatment for such patients. The aim of this study was to evaluate the effectiveness of average volume-assured pressure support (AVAPS) NIMV in patients with kyphoscoliotic chronic respiratory failure. The study was performed in 12 patients (mean age 49±11 years and body mass index 27.5±7.9 kg/m2) with advanced kyphoscoliosis complicated by severe respiratory failure (PaO2 6.68±0.34 kPa, SaO2 81.7±3.1%, PaCO2 9.51±1.08 kPa) treated by the NIMV. The short-term, after 5 days, and long-term, after 1 year of home treatment, efficacy of NIMV was evaluated. We found a significant improvement of diurnal PaO2 and PaCO2 on the 5th day of NIMV (an increase of 1.4±0.3 kPa and a decrease of 1.8±0.8 kPa, respectively; p<0.05) and after one year NIMV (an increase of 2.07±0.46 kPa and a decrease of 2.68±0.85 kPa, respectively; p<0.05). There was a significant increase of mean blood oxygen saturation during sleep on the 5th day (86.2±3.2%) and after 1 year of treatment (89.4±2.1%) compared with the baseline level (83.2±3.2%). The forced vital capacity also increased after 1 year (1,024±258 ml vs. the baseline 908±267 ml; p<0.05). The NIMV was well tolerated and no patient discontinued the treatment during the observation period. We conclude that AVAPS NIMV is an effective treatment option in kyphoscoliotic patients with chronic respiratory failure, resulting in a prompt and long-term improvement of daytime and nocturnal blood gas exchange.

Posterior vertebral column resection for correction of rigid spinal deformity curves greater than 100°

The surgical treatment of severe and rigid spinal deformities poses difficulties and dangers. In this article, the authors summarize their surgical techniques and evaluate patient outcomes after performing posterior vertebral column resection (PVCR) for the correction of spinal deformities with curves greater than 100°, and investigate the crucial points to ensure neurological safety during this challenging procedure. The authors retrospectively reviewed their experience with 28 patients with extremely severe (Cobb angles in the coronal or sagittal plane > 100°) and rigid thoracic or thoracolumbar spine deformities who underwent PVCR. The average patient age was 20.2 years and all patients underwent a minimum follow-up of 24 months (range 24-60 months). Patients were divided into groups according to their morphological classification as follows: kyphosis alone (Group A, 6 patients with a mean Cobb angle of 109.0° [range 105°-120°]); kyphoscoliosis with coronal plane curves notably greater than sagittal plane curves (Group B, 14 patients with mean scoliotic curves of 116.6° [range 102°-170°] and kyphotic curves of 77.7° [range 42°-160°]); and kyphoscoliosis with sagittal curves notably greater than coronal plane curves (Group C, 8 patients with a mean coronal curve of 85.4° [range 65°-110°] and a mean sagittal curve of 117.6° [range 102°-155°]). A total of 36 vertebrae were removed in 28 patients who had a severe rigid spinal deformity, and the mean fusion extent was 13.3 vertebrae (range 7-17 vertebrae). The mean operating time was 620 minutes (range 320-920 minutes) with an average operative blood loss of 6,680 ml (range 3,000-24,000 ml). The overall final correction rate of scoliosis was 59.0%, and average postoperative kyphotic Cobb angles ranged from 30.4° to 95.9°. In Group A the mean preoperative sagittal angle of 109.0° was corrected to a mean postoperative angle of 32.0°. In the Group B kyphoscoliotic patients, the correction rate in the coronal plane was 58.6%; the Cobb angle in the sagittal plane was corrected from a mean of 77.7° preoperatively to 25.1° postoperatively; in Group C, the correction rate in the coronal plane was 58.5%, and the mean sagittal angle was reduced from a mean of 117.6° preoperatively to 39.0°. Of the 28 patients who underwent PVCR, 46 complications were observed in 18 patients intra- and postoperatively. There were 5 neurological complications including 1 case of late-onset paralysis and 4 cases of thoracic nerve root pain, all of which resolved during the early follow-up period. Nonneurological complications occurred more often in kyphoscoliotic patients (41 complications). The mean follow-up of all patients was 33.7 months (range 24-60 months). Posterior vertebral column resection was effective in correcting severe rigid spinal deformity, although the procedure was technically demanding, exhaustingly lengthy, and was associated with a variety of complications. The PVCR technique created a space for spinal correction and spinal cord tension adjustment and the correction could be performed under direct inspection and by palpation of the tension in the spinal cord through the space. Therefore, in terms of the spinal cord, the deformity correction process involved in the PVCR procedure is relatively safe.

Kyphoscoliosis complicating pregnancy: maternal and neonatal outcome

To assess the outcome of pregnancies complicated by kyphoscoliosis in modern obstetric and orthopedic care. A total of 22 kyphoscoliotic patients with 34 pregnancies were identified from 46,828 pregnancies between 1998 and 2009. Their obstetric records and associated orthopedic problem were studied. The incidence of kyphoscoliosis complicating pregnancy was 0.072%. The mean age of the patients in their index pregnancy was 28.4 years (range 23-35), mean height 130 cm (range 125-138). The cause of kyphoscoliosis included idiopathic (majority), poliomyelitis and traumatic injury. Only 1 of the patient had previous spinal surgery. The cesarean rate was very high and none had any significant cardiorespiratory problem during anesthesia. There was no maternal or perinatal mortality. The high maternal and perinatal risks associated with kyphoscoliosis reported earlier no longer exist.

Corpectomy and circumferential spinal fusion in dystrophic neurofibromatous curves

Spinal deformity in neurofibromatosis, when associated with dystrophic change, is a major treatment challenge. Early anterior and posterior spinal fusion is the accepted treatment plan for severe progressive kyphoscoliosis. Resection of the vertebral body as an additional step in correction and fusion has not been previously investigated. Information on the functional status of the neurofibromatous curves is also scarce in the literature. The purpose of this study is to report an experience with corpectomy and circumferential fusion in dystrophic spines of neurofibromatosis. Among 16 patients with dystrophic spinal curves, nine cases who had undergone anterior and posterior fusion with 6.7years (range 2-11.9) average follow-up were evaluated clinically, radiographically, and functionally (SRS-22). Nine cases with a mean age of 11.8years (range 7.8-17) at surgery consisted of seven kyphoscoliotic patients, who had received one or two levels of cord decompression and corpectomy, and two cases of scoliosis with hypokyphosis. Surgery improved the mean preoperative scoliosis of 87 (range 60-110) and local kyphosis of 69.3° (range 50-100) to 49 (range 15-85) and 49° (range 35-70), respectively. Loss of correction of 5° in the scoliosis and 13° in the kyphosis angles was observed in the final follow-up. One surgery resulted in an immediate postoperative mortality. Fusion was achieved in all cases. The average SRS-22 score of 4.1 (range 3-4.6) was obtained. Simultaneous anterior and posterior fusion with corpectomy for dystrophic neurofibromatous spinal deformities is associated with a high fusion rate, good correction, and also good functional outcome.

Six minute walking test: an old tool with new applications

Six minute walking test: an old tool with new applications

Treatment of chronic respiratory failure in kyphoscoliosis: oxygen or ventilation?

Patients with kyposcoliosis and chronic respiratory insufficiency are treated either with home oxygen therapy or ventilation. Kyphoscoliotic patients demonstrate impaired ventilatory mechanics, consequently ventilation seems to be the treatment of choice. Yet, no randomised controlled trials (CRT) exist to prove it. Most investigators find it difficult to ethically justify a CRT. Therefore, the current authors performed the following retrospective study: survival and pulmonary function were analysed in all consecutive kyphoscoliotic patients who started long-term oxygen therapy (LTO group; n=15, aged 62+/-11 yrs (mean+/-SD)) or LTO plus nocturnal nasal intermittent positive pressure ventilation (nNIPPV group; n=18, aged 61+/-7 yrs) in the Dept of Pulmonology (University Hospital Gasthuisberg, Leuven) between 1990-2002. Prior to treatment partial pressure of oxygen (PO2) was lower, partial pressure of carbon dioxide (PCO2) tended to be higher and vital capacity (VC) tended to be lower in the nNIPPV group than in the LTO group (PO2 5.9+/-1 versus 6.7+/-0.9 kPa (44+/-8 versus 50+/-7 mmHg), PCO2 8+/-1 versus 7.3+/-0.9 kPa (60+/-8 versus 55+/-7 mmHg), VC 32+/-12 versus 40+/-16% predicted, or 645+/-244 versus 970+/-387 mL). In the nNIPPV group the 1-yr survival was higher (100% versus 66%). nNIPPV patients demonstrated an improvement in PO2 (breathing air) +54%, PCO2 (breathing air) -21%, VC +47% and maximal static inspiratory mouth pressure +33%; these improvements were absent in the LTO group. In conclusion, nocturnal nasal intermittent positive pressure ventilation, plus long-term oxygen therapy results in more favourable survival and changes in blood gases and respiratory function than long-term oxygen therapy alone.

Kyphoscoliotic Ventilatory Insufficiency: Effects of Long-term Intermittent Positive-Pressure Ventilation

To determine the effects of long-term nocturnal intermittent positive-pressure ventilation (NIPPV) on symptoms, pulmonary function test results, sleep, and respiratory muscle performance in patients with ventilatory insufficiency due to severe kyphoscoliosis. A prospective study in which 16 severe kyphoscoliotic patients were treated with NIPPV delivered by volume-cycled and pressure-cycled ventilators, over a period of 36 months. At baseline, pulmonary function tests, blood gas measurements, polysomnography, and respiratory muscle strength (measured by noninvasive indexes) were obtained. Symptoms and the number of hospitalizations in the previous 6 months also were recorded. Patients then began using a ventilator for > 1 to 2 days, in order to select the type of ventilator and the appropriate interface. Patients returned for evaluation (in outpatient setting) every 6 months for a follow-up period of 3 years. At 6 months, polysomnography was repeated, and by the third year clinical and functional parameters had been reassessed. All symptoms improved significantly with NIPPV therapy, when compared with the baseline values. The mean (+/- SD) PaO(2) and FVC values increased at 36 months compared with baseline values (62.6 +/- 7.1 vs 67.8 +/- 8.8 mm Hg, respectively; and 37.9 +/- 7.2% vs 47.5 +/- 11.9%, respectively; p < 0.05 for both). There were significant improvements in mean maximal inspiratory pressure (55.8 +/- 17.4 to 78.5 +/- 17.5 cm H(2)O), maximal expiratory pressure (53.8 +/- 17.7 to 72.3 +/- 11.0 cm H(2)O), mouth pressure (0.28 +/- 0.08 to 0.22 +/- 0.02 cmH(2)O), and pressure-time index (0.18 +/- 0.05 to 0.11 +/- 0.02; p < 0.05 for all comparisons). There were no significant differences in breathing pattern and ventilatory drive. After 6 months, nocturnal oxyhemoglobin saturation improved, however, there was no significant change in sleep architecture. All patients subjectively perceived a better quality of life after beginning ventilation, which persisted over the course of the study. Long-term NIPPV therapy improves daytime blood gas levels, respiratory muscle performance, and hypoventilation-based symptoms in patients with severe kyphoscoliosis.

Air leaking through the mouth during nocturnal nasal ventilation: effect on sleep quality.

Air leaking through the mouth has been reported in kyphoscoliotic patients receiving nasal ventilation via volume-limited ventilators. This study accessed the frequency of occurrence and effect on sleep quality of air leaking through the mouth during nocturnal nasal ventilation in patients with chest wall and neuromuscular disease using pressure-limited ventilation. Overnight and daytime polysomnography was performed in six stable experienced users of nocturnal nasal noninvasive positive-pressure ventilation (NPPV) who had chronic respiratory failure due to neuromuscular disease or chest wall deformity. All patients used the BiPAP S/T-D ventilatory support system (Respironics, Inc., Murrysville, PA). Measures included sleep scoring, leak quantitation, diaphragm and submental electromyograms (EMGs), and tidal and leak volumes. All patients had air leaking through the mouth for the majority of sleep. Sleep quality was diminished because of poor sleep efficiency and reduced percentages of slow-wave and rapid eye movement (REM) sleep. Air leaking through the mouth was associated with frequent arousals during stages 1 and 2 and REM sleep that contributed to sleep fragmentation, but arousals were infrequent during slow-wave sleep. Despite prevalent leaking, oxygenation was well maintained in all but one patient. Patients used a-combination of passive and active mechanisms to control air leaking. Although nasal ventilation improves nocturnal hypoventilation and symptoms in patients with restrictive thoracic disorders, air leaking through the mouth is very common during use. The leaking is associated with frequent arousals during lighter stages of sleep that interfere with progression to deeper stages, compromising sleep quality. Portable pressure-limited ventilators compensate for leaks, maintaining ventilation and oxygenation, but further studies are needed to determine which interfaces and ventilator techniques best control air leaking and optimize sleep quality.

Predicting resting energy expenditure in patients with musculoskeletal deformities

The aim of this study was to assess the validity of the commonly used equations (Harris-Benedict (HB), Schofield (S) and equations based on midarm circumference (MAC) and midarm muscle circumference (MAMC) in predicting resting energy expenditure (REE) in a population of patients with musculoskeletal deformities. 20 kyphoscoliotic patients (15 female (F); 5 male (M); mean age 59.6 years) and 10 controls (7 F; 3M; 59.8 years) were studied. REE measured by indirect calorimetry (IC) with a ventilated canopy system (Deltatrac metabolic monitor) was not significantly different between patients and controls (Mean (SD) REE (MJ/24 h): Patients: 5.48 (1.1); controls: 5.28(0.8)). In patients with deformities the Schofield equation gave values which were closest to measured REE (mean difference and limits of agreement IC vs S: 0.098 MJ/24 h; −0.822 and 1.018). The Harris-Benedict equation using height (Ht) and armspan (AS) in lieu of height also gave acceptable results (IC vs HB (Ht): 0.34; −0.638 and 1.318; IC vs HB (AS): 0.255; −0.683 and 1.253). Equations based on MAC and MAMC compared poorly (IC vs MAC equation: 0.398; −1.530 and 2.326; IC vs MAMC equation 0.687; −0.911 and 2.285). On regression analysis the equation REE = 0.295 (MAMC) + 0.0483 (AS) −0.0324 (age) −6.25 predicted REE best in the patient population (r 2 = 0.861).

Decay of inspiratory muscle pressure during expiration in anesthetized kyphoscoliosis patients.

The decay of pressure developed by the inspiratory muscles during expiration (PmusI) has not been studied in subjects with increased respiratory impedance such as in kyphoscoliosis. PmusI was compared in 11 anesthetized patients with kyphoscoliosis with that in 11 anesthetized normal subjects. PmusI was obtained according to the following equation: PmusI(t) = Ers.V(t) - K1V(t) - K2V2(t), where V is volume and V is airflow at any instant t during spontaneous expiration, Ers is the passive elastance, and K1V + K2V2 is the flow resistance (curvilinear in both groups because of the endotracheal tube and the intrinsic resistance in the kyphoscoliotics) of the total respiratory system. Ers was determined by the relaxation method and resistance from the ensuing V-V relationships during the ensuing relaxed expiration. Changes in impedance due to pliometric work done by the inspiratory muscles during relaxation were neglected. Subjects in both groups showed marked braking of expiratory flow by PmusI. The mean time for PmusI to decrease to 50 and 0% amounted to 17 and 8% less, respectively, in the kyphoscoliosis group. Average values for flow-resistive work in the control and kyphoscoliosis groups both amounted to approximately 40% of the elastic energy stored during inspiration. The remaining portion, used as negative work, amounted to approximately 60% in both groups. Expiratory braking in anesthetized kyphoscoliotic patients appears to be in proportion to their magnitude of elastic recoil and intrinsic flow resistance.

Another Complication of Thoracostomy—Perforation of the Right Atrium

Tube thoracostomy is an invasive procedure that is frequently life-saving but carries a risk of complications. We describe herein a complication not documented before-laceration of the right atrium. This occurred in a severely kyphoscoliotic patient with a markedly narrowed chest and led to his demise. This case attests to the extreme caution warranted when using trocar-type thoracostomy in patients with thoracic deformities.

A review of 50 pregnant patients with kyphoscoliosis.

An analysis of the obstetric and medical complications in 50 pregnant kyphoscoliotic patients is presented.

Anesthetic Management of Kyphoscoliotic Patients

Anesthetic Management of Kyphoscoliotic Patients

Respirator treatment in kyphoscoliotic patients

Respirator treatment in kyphoscoliotic patients

Physiologic Evaluation and Treatment of Kyphoscoliotic Patients

Article1 July 1961Physiologic Evaluation and Treatment of Kyphoscoliotic PatientsISRAEL BRUDERMAN, M.D., MYRON STEIN, M.D.ISRAEL BRUDERMAN, M.D.Search for more papers by this author, MYRON STEIN, M.D.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-55-1-94 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptNew techniques of investigation have clarified the nature of the abnormalities of pulmonary function in patients with severe kyphoscoliosis. Restricted lung volumes, alveolar hypoventilation, hypercapnia, arterial oxygen unsaturation, and normal distribution of inspired air have been observed in these patients. However, arterial oxygen unsaturation when it occurs is unusually large for the degree of alveolar hypoventilation. Previous investigations have eliminated a diffusion abnormality (1) or atelectasis as a basis for this defect. The present study is concerned with the problem of arterial oxygen unsaturation and with the therapy of the acutely ill kyphoscoliotic patient.PATIENTS AND METHODSPATIENTSThree male...

Torsion of the gallbladder in a kypho-scoliotic patient.

Torsion of the gallbladder in a kypho-scoliotic patient.