Mean Preoperative Height Research Articles

Surgical Outcome of Three-Dimensional Correction of Adolescent Idiopathic Scoliosis

Background: Adolescent idiopathic scoliosis is an abnormal curvature of the spine that appears in late childhood or adolescence. Instead of growing straight, the spine develops a side-to-side curvature, usually in an elongated S or C shape; the bones of the spine are also slightly twisted or rotated. To prevent further curve progression and obtain a balanced spine, surgery remains the mainstay of treatment for idiopathic scoliosis (IS). Objective: This study aimed to discuss three dimensional surgical techniques used for correction of adolescent idiopathic scoliosis, evaluating their feasibility, efficacy and safety. Patients and methods: This study was conducted in Mansoura University Hospital and Alexandria University Hospitals between September 2018 and April 2021. 3D surgical correction was performed for 91 patients complaining of idiopathic scoliosis, and not responding to conservative measures and not associated with neurological affection. Results: According to Lenke classification, there were 56 patients (61.5%) with type 1 curve type , 9 patients (9.9%) with type 2, 7 patients (7.7%) with type 3, 7 patients (7.7%) with type 5 and 12 patients (13.2%) with type 6. Mean preoperative height was 1.60 m while mean postoperative height was 1.66 m. with significant increase in height postoperatively (p < 0.001). Mean percentage height gain was 3.91%. Conclusion: We do believe that the posterior only approach 3D correction is an effective method in management of AIS concerning correction of Cobb angle, shoulder balance and spinopelvic parameters and recommend it as the best way nowadays to treat this disease.

Vertebral Body Replacement With an Anchored Expandable Titanium Cage in the Cervical Spine: A Clinical and Radiological Evaluation.

Expandable cervical cages have been used successfully to reconstruct the anterior spinal column. To perform clinical and radiological evaluation of vertebral body replacement with an anchored expandable titanium cage in the cervical spine after single-level and 2-level corpectomies. Between 2011 and 2017, 40 patients underwent a single-level (N=32) or 2-level (N=8) anterior corpectomy and fusion using an anchored expandable vertebral body replacement cage. Clinical and radiological data at admission, postoperatively, and at 3- and 12-mo follow-up were retrospectively analyzed. Clinical assessment was performed via standardized neurological evaluation, Odom score, and McCormick classification. Radiological assessment was performed via evaluation of sagittal profile, postoperative position, fusion, and subsidence rates. Mean last follow-up was 14.8±7 mo. Overall clinical and myelopathy-related improvements were shown directly after operation and at last follow-up. A stable centralized positioning of cages was achieved in 37 patients (93%). A mild ventral (>1.5 mm) malplacement was noted in 3 patients (7%) without clinical consequences. Sagittal alignment and preoperative cervical kyphosis improved significantly (7.8° gain of lordosis) and remained stable. Mean preoperative height of operated segments increased by 10 mm postoperatively and remained stable. Fusion rate in non-neoplastic patients and subsidence rate at last follow-up comprised 87.5% and 17.8%. With exception of 1 patient suffering from severe osteoporosis and cage subsidence, no patient needed additional secondary stabilization. Anterior corpectomy and fusion by an expandable anchored titanium cage with anchor screws without additional instrumentation resulted in overall clinical improvement and radiological anterior column support, achieving significant and reliable restoration of the physiological sagittal cervical profile.

Predictors of demand for liver transplantation in children undergoing Kasai portoenterostomy for biliary atresia

Context Biliary atresia (BA) remains the most common indication for pediatric liver transplantation worldwide. Ultimately, 50–80% of BA patients will require a liver transplant Thus, much of the research in the field has focused on identifying predictors for transplant and optimizing the efficacy of Kasai portoenterostomy (KPE), in order to decrease the need for transplantation and avoid the risks of lifelong immunosuppression. Aim The aim of this study was to identify perioperative risk factors for the need of liver transplantation following KPE operation for BA. Patients and methods A retrospective analysis of 150 patients undergoing KPE for BA at Hepatobiliary and Pancreatic Surgery Department, National Liver Institute, Menoufia University, from May 2013 to May 2018, was carried out. Patients were divided into two groups: group one included 73 (48.7%) patients who survived without the need for liver transplantation and group two included 77 (51.3%) patients with mortality, listed for liver transplantation or transplanted; thereafter, logistic regression analysis was used to identify the independent predictors of cases needing liver transplantation. Statistical analysis used Continuous variables were expressed as mean±SD and categorical variables as proportions. Univariate analysis for the two groups were carried out using the independent samples t test for continuous variables and χ2 test for categorical variables. Logistic regression analysis was used to identify the independent predictors of cases needing liver transplantation. Receiver operating characteristic analysis was used for the cut-off determination of predictive parameters using MedCalc application, version 18.2.1. Results The mean age at the time of operation was 74.9±14.6 days after birth (range, 31–111 days); there were 70 (46.7%) male babies and 80 (53.3%) female babies. The mean preoperative weight was 4.6±0.6 kg, while the mean preoperative height was 57.3±3.58 cm. Total bilirubin and albumin levels at 1 and 3 months following KPE were associated with death or the need for liver transplantation; however, only a total bilirubin level of more than 6 mg/dl at 3 months is an independent predictor of the need for liver transplantation. Age at the time of KPE and postoperative steroid use were not associated with improved transplant-free survival. Conclusion Total bilirubin level of more than 7.3 mg/dl at 1 month and a level of more than 6 mg/dl at 3 months after KPE are predictive of the need for liver transplantation (P

Long-Term Effects of Adenotonsillectomy on Growth and Symptoms in Childhood

Background and Objectives This study was performed to evaluate the long-term effect of adenotonsillectomy on childhood growth by examining preoperative growth status and presenting symptoms. Subjects and Method One hundred and four patients who underwent adenotonsillectomy from January to December 2009 were enrolled in this study. Clinical data were collected from medical record reviews and through the administered questionnaire. We investigated symptoms and growth changes during 5 years following the surgery. Results The mean age of patients was 6.0±1.94 years (range, 3-10), with the male to female ratio of 62:42. Pre-operative symptoms were significantly improved after the surgery. The mean pre-operative height and weight percentiles were 53.6±27.4 and 59.6±29.2 at initial evaluation, and 67.1±26.4 and 59.6±28.6 at 5 years post adenotonsillectomy (p＜0.001, p=0.989), respectively. An increase in height percentile was more prominent in patients whose pre-operative height percentile was less than 50 compared to those with a percentile of 50 or more (p＜0.001). Weight percentile was significantly increased in those with the pre-operative weight percentile of less than 50 and decreased in patients with a percentile of 50 or more. Conclusion Adenotonsillectomy has a positive effect on height growth in children with adenotonsillar hypertrophy, especially in patients whose height percentile is less than 50. Weight gain also can be expected in preoperative low-weight children. Key words: Adenoidectomy ㆍ Child ㆍ Growth ㆍ Tonsillectomy

Cosmetic lengthening: what are the limits?

ObjectivesIn the last decades, limb lengthening has not been limited to the treatment of patients with dwarfism and deformities resulting from congenital anomalies, trauma, tumor and infections, but, has also been used for aesthetic reasons. Cosmetic lengthening by the Ilizarov method with circular external fixation has been applied to individuals with constitutional short stature who wish to be taller.Materials and methodsFrom January 1985 to December 2010, the medical records of 63 patients with constitutional short stature (36 M, 27F; 126 legs) who underwent cosmetic bilateral leg lengthening using a hybrid advanced fixator according to the Ilizarov method, were reviewed, retrospectively. The mean age was 24.8 years, while the mean preoperative height was 152.6 cm. Paley’s criteria were used to evaluate problems, obstacles, and complications from the time of surgery until 1 year after frame’s removal.ResultThe mean lengthening achieved in all patients was 7.2 cm (range: 5–11 cm), with a mean duration of treatment of 9 months and 15 days (range: 7–18 months). The mean follow-up time was 6.14 years (range 1–10).ConclusionThe cosmetic leg lengthening was helpful to all patients, improving their social capabilities and self-confidence. All patients considered their stature as normal and they reported satisfaction and gratification with important changes in their professional and personal life. Cosmetic leg lengthening may raise some ethical objections and for that reason patients should be well informed about all the risks and complications related to this type of surgery.

Cosmetic lower limb lengthening by Ilizarov apparatus: what are the risks?

Compelled by the psychosocial implications of short stature, patients with short stature are increasingly undergoing distraction osteogenesis for cosmetic limb lengthening. To the degree that this is true, evaluation of the risks and benefits of this treatment are very important, but to date, there are few studies reporting on using distraction osteogenesis for this indication. We reviewed a group of patients undergoing cosmetic lower-extremity lengthening in terms of (1) soft tissue challenges, (2) bone-related complications, and (3) functional and subjective clinical outcomes. The study was retrospective by reviewing data from medical records and radiographs. Between 1983 and 2006, we treated 138 somatically normal patients with bilateral lower-limb distraction osteogenesis for cosmetic purposes at our center using an Ilizarov external fixator, of whom 131 (95%; 65 males, 66 females) had complete clinical and radiographic data a minimum of 1year after treatment (mean, 6years; range, 1-14years) and were reviewed for this report. The mean age of these patients was 25years (range, 14-68years) and their mean preoperative height was 159cm (range, 130-174cm). One hundred twenty-four (95%) patients had lengthening of the tibia alone, of which 66 (53%) were monofocal and 58 (47%) were bifocal. Six patients (4.58%) had crossed contralateral lengthening of the femur and tibia and one patient (0.76%) had bilateral lengthening of the femur. The mean height gained was 6.9cm (range, 2-13cm), 7.3cm (range, 3.5-13cm) in males and 6.5cm (range, 2-13cm) in females. The mean lengthening, maturation, and external fixator indexes were 12days/cm (range, 4.3-24days/cm), 19days/cm (range, 5.2-63days/cm), and 31days/cm (range, 12-78days/cm), respectively. Forty-eight patients (37%) had 59 complications related to treatment. Thirty-seven were soft tissue related (28%), of which 17 (46%) needed reinterventions, and 22 were bone related (17%), of which 16 (73%) needed reinterventions. At final followup, the outcome was excellent for 72 patients (55%), good for 52 (40%), satisfactory for six (4.58%), and poor for one (0.77%). One hundred thirty of 131 patients subjectively felt satisfied and had improved self-esteem. Distraction osteogenesis using the Ilizarov external fixator is an option for carefully selected motivated patients with awareness of this technique. Soft tissue and bone-related complications including those that necessitate reinterventions should be expected during the course of treatment, although most can be managed without permanent sequelae or disability. Future studies with more robust methods will need to determine whether the risks and benefits of this procedure are well balanced. Preoperative counseling, considering the ethical questions this procedure can raise, is of paramount importance for the patient to weigh the risk versus anticipated benefits. Studies from other centers will be important as we move forward. Level IV, therapeutic study. See the Instructions for Authors for a complete description of levels of evidence.

Co-morbidity resolution in morbidly obese children and adolescents undergoing sleeve gastrectomy

BackgroundBariatric surgery is becoming important for the reversal of co-morbidities in children and adolescents. We previously reported the safety and efficacy of laparoscopic sleeve gastrectomy (LSG) in the pediatric population. However, evidence pertaining to the effect of LSG on co-morbidities in this age group is scarce. The objective of this study was to assess the remission and improvement of co-morbidities (dyslipidemia, hypertension, diabetes, and obstructive sleep apnea) after LSG in children and adolescents. MethodsAnthropometric changes, complications, remission, and improvement in co-morbidities were assessed over 3 years. OSA was diagnosed using the Pediatric Sleep Questionnaire (PSQ) and polysomnography and its resolution was assessed according to PSQ score alone. Diabetes, prediabetes, hypertension, prehypertension, and dyslipidemia were assessed using standard pediatric-specific definitions. ResultsThe review yielded 226 patients; 74 patients were prepubertal (5–12 yr of age, mean: 9.8±2.3), 115 adolescents (13–17 yr of age, mean: 15.4±1.7), and 37 were young adults (18–21 yr of age, mean: 19.2±.8). Overall mean age was 14.4±4.0 years (range: 4.94–20.99), and 50.4% were females. Mean body mass index (BMI) and BMI z score were 48.2±10.1 kg/m2 and 2.99±.35, respectively. Mean BMI z score at 1, 2, and 3 years postoperative was 2.01±.87, 2.00±1.07, and 1.66±.65, respectively. Mean preoperative height was 158.0±15.1 cm, and at 1, 2, and 3 years postoperative, it was 160.3±13.4, 161.4±14.1, and 163.2±11.1, respectively. All patients at different age groups experienced normal growth velocity. Within 2 years of follow-up, 90.3% of co-morbidities were in remission or improved, 64.9% of which were within the first 3 months postoperatively. No further improvement or remission was observed beyond 2 years, and there was no recurrence up to 3 years in patients who were seen in follow-up. The lost to follow-up in each of the 3 years was 4.2%, 7.6%, and 15.3%, respectively. ConclusionLSG performed on children and adolescents results in remission or improvement of>90% of co-morbidities within 2 years after bariatric surgery with few complications, no mortality, and normal growth.

Direct v/s Indirect sinus lift in maxillary dental implants

Introduction:Lack of sufficient bone height along maxillary sinus poses significant difficulty for placement of implants in edentulous maxillary jaw. Minimally invasive sinus augmentation is an effective solution for this problem. The manuscript intends to present long period results of such augmentation using direct (DSAT) and indirect (ISAT) minimally invasive sinus augmentation technique (SAT) from a single center.Materials and Methods:Records of patients who required minimally invasive sinus augmentation to increase residual bone height for implant placement fulfilling predetermined exclusion and inclusion criteria. Only patients with follow-up records for at least a year were considered. Both DSAT and ISAT were employed for sinus augmentation. The age, gender, period of edentulousness, alveolus thickness at crestal level during the pre- and postoperative assessment, implant length, and diameter of implants were collected from case histories. Descriptive statistics, Chi-square, paired test, and one way analysis of variance (ANOVA) was used appropriately. P ≤ 0.05 was considered as significant.Results:There were 197 implants placed and mean age of the group was 40.2 ± 10.7 years. There was a slight male predilection (54.3%). The gain in bone height as expressed in percentage after a year was 134.6%. On comparing the length of residual alveolar bone (RAB) at start and end of study, ISAT had a mean preoperative height of 7.88 mm while postoperative height was 13.22 mm. For DSAT, the mean height at start of treatment was 3.94 mm while at the end it was 10.13 mm. The mean increase in height was 6.19 mm. For both cases, P was 0.000.Discussion:Age, gender, and period of edentulism did not influence the outcome. The alveolar width appears to differ and influence the outcome. When alveolar width increases, wider diameter implants can be placed by compromising height. Thus it is a clinical acumen that would be extremely helpful to gauge the outcome of the condition.

Increase in spinal longitudinal length by correction surgery for adolescent idiopathic scoliosis

One of the downsides of spinal correction surgery for adolescent idiopathic scoliosis (AIS) is the cessation of spinal longitudinal growth within the fused levels in growing children. However, the surgery itself has the potential to increase spinal longitudinal length by correcting the curvature. The purpose of this study was to evaluate the correlation between curve correction and increased spinal longitudinal length by corrective surgery for AIS. This study included 208 consecutive patients (14 male, 194 female) with AIS who underwent posterior or anterior correction and fusion surgeries. Mean age at the time of surgery was 15.7±3.3years (range 10-20years). Patients with hyperkyphosis of more than 40° were excluded. All patients had main curves in the thoracic spine (Lenke type 1 or 2). Forty-three patients underwent anterior spinal correction and fusion (ASF) and 164 underwent posterior spinal correction and fusion (PSF). The mean preoperative height was 154.7±6.9cm (range 133-173cm). Pre and postoperative PA standing X-ray films were used to measure the Cobb angle and spinal length between the end vertebrae of the main thoracic curve, and between T1 and L5. The patients were divided into ASF and PSF groups, within which correlations between the Cobb angle correction and spinal length increase were evaluated. In the ASF group, the mean preoperative Cobb angle of the main thoracic curve was 54.9±8.3° (range 41-83°) and it was corrected to 19.7±9.5° (range 0-47°) with a mean correction of 35.2±11.1° (range 10-74°) after surgery. The mean increase in the length of the main thoracic curve was 1.5±4.6mm (range -8 to 13mm), and the mean increase in T1-L5 length was 16.6±7.7mm (range -3 to 51mm). Significant correlation between the correction of the Cobb angle and increase in T1-L5 length was observed, with a correlation coefficient of 0.44. In the PSF group, the mean preoperative Cobb angle of the main thoracic curve was 58.8±11.6° (range 36-107°) and it was corrected to 17.1±7.6° (range 10-49°), with a mean correction of 41.7±10.2° (range 21-73°) after surgery. The mean increase in the length of the main thoracic curve was 14.0±5.2mm (range 0-42mm), and the mean increase in T1-L5 length was 32.4±10.8mm (10-61mm). Correlation between the correction of the Cobb angle and increase in T1-L5 length was high, with a correlation coefficient of 0.64. The increase in T1-L5 length could be calculated by the following formula based on linear regression analysis: increase in T1-L5 length (mm)=correction of the Cobb angle (º)×0.77. Spinal longitudinal length was significantly increased after surgery in both the ASF and PSF groups. Correction of the Cobb angle and increase in T1-L5 length were highly correlated with each other, especially in the PSF group.

Tibial Lengthening Over an Intramedullary Nail with Use of the Ilizarov External Fixator for Idiopathic Short Stature

The details regarding bone formation and complication rates associated with tibial lengthening over an intramedullary nail with use of the Ilizarov external fixator have not been reported, to our knowledge. The purpose of this study was to review our experiences with this procedure, performed in individuals with idiopathic short stature. In addition, we compared the results of lengthening over a nail, in terms of the observed bone formation and the complications, with those of the conventional Ilizarov method. Eighty-eight tibiae in forty-four individuals with a mean preoperative height (and standard deviation) of 153.7 +/- 7.2 cm were included in the study. Thirty-two tibial lengthening procedures were performed with the conventional method and fifty-six, with a nail. The increase in the length of the tibia, the external fixation index, the healing index, and complications were assessed. Three specific concerns, including mobility during the lengthening procedure, the time interval before the patient could return to previous activities after completion of the lengthening, and physical activities at the time of final follow-up, were also assessed. The mean final height was 160.1 +/- 7.0 cm, and the mean gain in tibial length was 6.2 cm (20.0%). There was no difference in the mean gain in tibial length or the healing index between the groups; however, the external fixation index was lower and there were fewer complications per tibia in the group treated with the lengthening over a nail. The individuals treated with lengthening over a nail coped better with outdoor activities during the treatment period than the individuals treated with the conventional Ilizarov method; however, there was no difference in the time until the individual returned to previous activities or in the ability to carry out physical activities at the time of final follow-up between the groups. Tibial lengthening with use of the Ilizarov external fixator over an intramedullary nail results in new bone formation of a quality equal to that obtained with the conventional Ilizarov method; however, it reduces the duration of external fixation and the rate of complications.

Video-assisted thoracoscopic surgery (VATS) for the treatment of scolioticrib hump deformity

A retrospective study of 21 patients with idiopathic scoliosis who underwent endoscopic thoracoplasty was done. The objective of the study was to report and assess the morbidity and mid term outcomes of video-assisted thoracoplasty in idiopathic scoliosis. Patients with idiopathic scoliosis often present cosmetic complaints due to their rib deformity. This deformity may still exist after surgical correction of the main scoliotic curve. Endoscopic thoracoplasty has been reported as a safe method in limited cases of idiopathic scoliosis. Between 2002 and 2004, 21 patients underwent endoscopic anterior release and thoracoplasty for significant rib hump deformity associated with idiopathic scoliosis. Patients were operated on lateral position, with two endoscopic ports. Anterior release and rib resection were performed during the first stage, and instrumented posterior fusion was performed in a second stage. Patients were evaluated preoperatively, 1 week after surgery, 6 months after surgery and at their most recent follow-up with clinical and radiological measurement of the rib deformity. The mean age at surgery was 14.9 years old (range 13-17 years). The average Cobb's angle of the main scoliotic curve was 70 degrees (range 60 degrees -85 degrees). Average follow-up was 25 months (range 23-32 months). The mean number of resected ribs was five ribs (range 4-7) and the mean length of the resected rib was 4.2 cm (range 2.2-7 cm). Average operating time of endoscopic thoracoplasty (including anterior release) was 65 min (range 45-108 min). The mean preoperative height of rib hump deformity was 3.6 cm (range 2.5-5.5 cm). It was reduced to 1.5 cm at most recent follow-up. There was no significant thoracic pain necessitating medication postoperatively. No complications related to endoscopic anterior release and rib hump resection occurred in the series. Endoscopic thoracoplasty is a safe and reliable technique in idiopathic scoliosis. If indicated, the anterior release can be performed with video-assistance and the thoracoplasty can be performed on the same stage.

Influence Of Enterocystoplasty on Linear Growth in Children With Exstrophy

Many children with bladder exstrophy undergo reconstruction incorporating bowel into the lower urinary tract, which may result in metabolic changes affecting height. Linear growth in children with exstrophy who underwent enterocystoplasty was studied. We retrospectively reviewed the charts of children with classic bladder exstrophy who underwent bladder augmentation with small or large bowel, or creation of a bowel neobladder before age 11 years. Mean followup plus or minus standard error was 9.4 +/- 0.9 years. Most patients were assessed yearly with measurement of height and serum electrolytes. Metabolic acidosis was treated with oral bicarbonate. Preoperative height percentiles at enterocystoplasty were compared to height percentiles at the most recent visit. In addition, height percentiles in a control group of individuals with exstrophy who did not undergo enterocystoplasty were compared to postoperative height percentiles in the enterocystoplasty group. The t test was used for statistical analysis. Data on 18 children who underwent bladder reconstruction with bowel were compared with those on a control group of 18 with exstrophy. The mean preoperative height percentile at a mean age of 5.2 years was 35.6 +/- 4.5 and the postoperative height percentile at a mean age of 14.6 years was 20.3 +/- 5.7 (p <0.01). The mean height percentile in the control group at a mean age of 15.2 years was 30.6 +/- 7.8 (p <0.01 versus the postoperative height percentile in the study group. In the enterocystoplasty group 2 patients were receiving oral bicarbonate for metabolic acidosis. Five patients who underwent enterocystoplasty and 6 controls were below the third percentile for height. In children with bladder exstrophy bladder augmentation or neobladder creation may have an adverse effect on linear growth. The height of children with bladder exstrophy is less than average compared with standard growth charts.