Operative Treatment Of Scoliosis Research Articles

Operative treatment of scoliosis in proximal spinal muscular atrophy: results of 41 patients

The early development of progressive scoliosis with pelvic obliquity is the most significant orthopaedic problem for non-ambulatory children with spinal muscular atrophy (SMA). 24 SMA patients were operated on for scoliosis using the ISOLA(®) system and 17 patients using a telescopic rod. The average age at spinal surgery was 12.3years (6.5-22.7) in the ISOLA(®) group and 6.7years (4.8-10.9) in the telescopic rod group. The Cobb angle was corrected on average from pre-operative 83°(54°-120°) to post-operative 39°(5°-70°) in the ISOLA(®) group and, respectively, from 62°(28°-86°) to 18°(0°-34°) in the telescopic rod group. Mean loss of correction at mean follow-up of 6years (3-10) was 6°(0°-33°) in the ISOLA(®) group and at mean follow-up of 8.6years (3-12) 13°(0°-49°) in the telescopic rod group excluding the patients with rod failure. The vital capacity is not worsened by these operations in comparison to the natural course. After telescopic rods were implanted, there were some unsatisfactory results due to crankshaft phenomenon and an increase of pelvic obliquity. Our recommendation for non-ambulatory SMA patients is to have definitive stabilisation using multisegmental instrumentation, starting from the age of 10 to 12years.

Adolescent idiopathic scoliosis with rapid progression – a case report

Case report A 15-year-old girl having right thoracic scoliosis with documented progression of 100 Cobb degrees within 2 years is presented. Medical history: Until the age of thirteen the girl developed normally, then the parents noted trunk asymmetry. The girl was radiographed and right thoracic scoliosis was diagnosed. Cobb angle was 20 degrees (Th7-L2), Risser sign 1. No signs of congenital curvature. The girl was advised to wear a brace and perform exercises but did not do. First admitted to our department at the age of 15. Menarche has not appeared. On examination severe trunk imbalance, right rib hump 30 degrees of Bunnell. The curve was stiff, left rib arch touching the iliac crest. There were 4 cafe-au-lait spots, but diagnose of neurofibromatosis was ruled out with genetic exam. X-ray revealed right thoracic scoliosis 125 degrees of Cobb (Th7-L2), Risser sign 3. Supine bending X-ray revealed correction to 100 degrees (20%). Vital capacity was 40%. MRI exam did not show central nervous system disturbances. The patient was qualified to staged operative treatment of scoliosis combined with regular respiratory exercises and had already the first surgery resulting in correction to 67 degrees. Conclusions Medical history, clinical examination, radiography and MRI did not reveal any data to predict unusual course of scoliosis.

Operative Treatment of Scoliosis in Patients With a Fontan Circulation

A retrospective chart and radiographic review of patients with a Fontan physiology who underwent surgical correction of their scoliosis. To evaluate the operative and perioperative treatment of patients with a Fontan physiology and scoliosis. The survival rates in patients with complex congenital heart disease are improving, thus creating a subset of patients with complex physiology who will require surgical treatment of their scoliosis. The Fontan physiology is created surgically in patients born with a single functioning ventricle. These patients represent a significant anesthetic risk during spinal surgery, given their physiologic need for a sustained systemic preload. Currently, to our knowledge, there are no published series in the literature regarding the operative treatment of scoliosis in these patients. We reviewed our experience with the operative treatment of scoliosis in 7 patients with a Fontan circulation. There were 7 patients identified who were treated with correction and arthrodesis using modern segmental instrumentation. A radiographic and chart review was performed to assess the operative and perioperative treatment. Mean age at surgery was 14 years 9 months, and mean Cobb angle was 75 degrees . There were no intraoperative complications; however, postoperative complications were frequent and significant: 1 delayed paralysis, 2 superior mesenteric artery syndromes, 1 renal tubular necrosis, 2 pulmonary complications, 1 Horner syndrome, and 1 urinary tract infection. Operative treatment of scoliosis in these patients may be successful; however, complications are frequent and significant.

Operative Treatment of Scoliosis With the Kaneda Anterior Spine System

Prospective, single-cohort study. To evaluate thoracic and thoracolumbar scoliosis using the Kaneda anterior spine dual-rod system (KASS). In selected cases, anterior correction of scoliosis has several advantages over the traditional posterior instrumentation. Other than 2 primary reports by Kaneda, there are no clinical outcome reports with the KASS in the literature. A total of 24 patients with thoracic (n = 10)/thoracolumbar (n = 14) scoliosis were corrected using the KASS. Sagittal and coronal plane radiologic parameters were evaluated before surgery, 1-year after surgery, and at final follow-up (approximately 40 months). Average coronal correction of the primary curve was from 61 degrees to 24 degrees (61%). Apical vertebral rotation decreased by 69%. Apical vertebral translation decreased 10-2 cm. The secondary thoracic and lumbar curves showed a spontaneous correction between 27% and 46%, respectively. Thoracic kyphosis increased 25 degrees -38 degrees (52%), lumbar lordosis showed a minimal decrease from 48 degrees to 43 degrees . Fusion was achieved in all cases. No neurovascular or implant-related problems were observed at final follow-up. Anterior instrumented fusion for thoracic/thoracolumbar scoliosis using the KASS is a good treatment option for idiopathic thoracic/thoracolumbar curves.

Iatrogenic paraplegia in spinal surgery

Paraplegia as a result of a surgical spinal procedure is a rare complication. The risk cannot be precisely quantified due to the lack of current data. The aim of this study was to record a sufficiently large number of major spinal operations, especially extended methods in scoliosis surgery. Hereby, a reliable statement regarding the risk of severe neurological complications with these surgical techniques should be possible. First, a retrospective analysis of patients from a German spine centre (spinal fusion) and a survey of 17 German centres of spinal surgery were conducted for the retrospective acquisition of severe iatrogenic neurological complications. The study included 1194 patients who underwent a spinal fusion during the period 1992-2002. The incidents of postoperative paraplegia are described in detail, and case studies done. Possible causes, methods of intraoperative monitoring and options of therapy are discussed according to research in relevant publications. Additionally, severe neurological complications of 3115 spinal operations were recorded in a standardised survey conducted throughout major German spinal centres. Of the 1194 patients surveyed, 7 (0.59%) experienced a postsurgical complete or incomplete paraplegia. In 3 of the recorded cases, the cause could be identified. The survey of 3115 scoliosis surgeries showed that iatrogenic paraplegia occurred with a frequency of 0.55%. The risks associated with short spinal fusions (0.14%), cervical discectomies (0.07%) and lumbar discectomies (0.03%) are considerably less. Operative treatment of scoliosis with a high degree of correction carries a risk of neurological complications of about 0.5%. Mechanical as well as ischaemic damage to the spinal cord can be detected early by means of consistent intraoperative neuromonitoring.

Point of View: Operative Treatment of Scoliosis With Cotrel-Dubousset-Hopf Instrumentation

Point of View: Operative Treatment of Scoliosis With Cotrel-Dubousset-Hopf Instrumentation

Scoliosis in familial dysautonomia. Operative treatment.

The results of operative treatment of scoliosis were reviewed for twenty-two patients (ten boys and twelve girls) who had familial dysautonomia, an autosomal recessive disorder affecting primarily Ashkenazi Jews. The indication for operative intervention was progressive kyphoscoliosis to 45 degrees or more in a skeletally immature patient for whom bracing had failed. The mean age at the time of the operation was fifteen years and five months (range, eight years and two months to nineteen years). Seventeen patients had a thoracic curve with a mean preoperative Cobb angle of 69 degrees (range, 47 to 112 degrees), and five patients had a double major curve with a mean preoperative Cobb angle of 71 degrees (range, 42 to 87 degrees) for the cephalad curves and 60 degrees (range, 45 to 72 degrees) for the caudad curves. Twenty patients had a rigid kyphosis; in fourteen, the apex was at the seventh thoracic vertebra or more cephalad. Two patients had a lordoscoliosis. The mean preoperative kyphosis was 64 degrees (range, 12 to 110 degrees) in the thirteen patients who had a thoracic curve and for whom information regarding kyphosis was available, and it was 70 degrees (range, 54 to 84 degrees) in the five patients who had a double major curve. Postoperior spinal arthrodesis and instrumentation was performed in all patients. Two patients had an anterior arthrodesis as well because of the severity and rigidity of the curve. Allograft bone was used in eighteen patients. Postoperatively, all patients were managed with a body cast or with a custom-molded thoracolumbar brace.(ABSTRACT TRUNCATED AT 250 WORDS)

The operative treatment of spinal deformities in MMC.

The results of the operative treatment of scoliosis in 12 patients with MMC and in two patients with associated severe kyphosis are presented. In scoliosis only multi-segmental methods combined with ventral procedures allow a postoperative care without brace or cast. The angle before and after operation with the CDI or CDI/VDS procedures averaged 80.3 degrees and 38.2 degrees respectively (mean corrections of 41.5 degrees and 51.6%). The results show that patients with scoliosis with MMC had a approximately 30% greater preoperative angle than patients with idiopathic scoliosis. An early operation (in progressive curves with more than 30 degrees) may reduce the number and severity of complications.

THE CLINICAL MANAGEMENT OF MUSCULAR DYSTROPHY AND ASSOCIATED NEUROMUSCULAR DISEASES

The natural history of muscular dystrophy is such that force imbalances, produced by muscle weakness and contracture, cause progressive postural decompensation. Ultimately, the patient loses the ability to position his center of gravity over the base of support, becoming wheelchair-bound by late puberty. After this, the disease follows a rapidly declining course, terminating in early death.In selected patients, properly timed surgery and bracing has enhanced standing balance and significantly extended the ability to ambulate. Because severe weakness can result from prolonged restraint, operative procedures must permit immediate mobilization without excessive pain or wound dehiscence. Conditions requiring surgical correction are lower extremity flexion contracture, metatarsus adductus, rigid forefoot equinovarus and calcaneocavus. Techniques designed to correct these deformities, and still permit early postoperative mobilization, include subcutaneous tenotomy and percutaneous tarsal medullostomy. Postoperative plastic bracing improves walking mechanics through mild knee flexion and ischial seating.Progressive disability in these diseases can be delayed by a variety of physiatric techniques, including the prescription of appropriate orthoses and aids to daily living. Where feasible, fractures are treated with minimal splintage and early ambulation. After patients are no longer ambulatory, they require suitable wheelchairs and a variety of special devices to facilitate ongoing care. Orthotic and operative treatment of scoliosis provides wheelchair-confined patients, with either myopathy or neuropathy, increased comfort and improved cardio-respiratory function, while freeing the upper extremities for functional tasks.Although most muscle diseases are incurable, this is not synonymous with untreatable Optimal therapy for the patient with muscle disease should be multidisciplinary, aggressive, and conducted in an atmosphere of intelligent concern. This approach minimizes the frustrating aspects of these conditions, while maximizing the benefits obtained through available care, enabling the patient to live as fully as possible for as long as possible.

An apparatus for the operative treatment of scoliosis

An apparatus for the operative treatment of scoliosis

Operative treatment of scoliosis with Harrington instrumentation technique.

Thirty-five patients with scoliosis were treated with posterior fusion including the Harrington instrumentation technique. The operation was followed by a 1-year period of treatment in a Milwaukee brace. The patients had a thoracic or a thoracolumbar curve averaging 74 degrees. The mean initial correction was 45 per cent, and the mean final correction 33 per cent, after 2 3/4 years. There were no cases of pseudarthrosis and only one case of transient paresis. There were no deaths. It is concluded that these results are satisfactory and that the method is a safe one in experienced hands.

Operative treatment of scoliosis with the Harrington instrumentation technique.

Preliminary results of treatment of scoliosis with the Harrington instrumentation technique in 80 patients are presented. The curve correction at operation averaged 43.4% with the best results being achieved in idiopathic single curves (49.3%). Most of the patients had been treated conservatively for a long time prior to operation, and the curves were rather stiff. The initial loss of correction was 3.2 degrees, and the overall loss at 2 years postoperatively averaged 6.5 degrees in 28 patients. Complications occurred in 22.5% of the patients, most often at the upper hook site. Serious complications were rare. It is concluded that the Harrington instrumentation technique is an effective means of treatment of scoliosis.

New technics in the operative treatment of scoliosis.

Preoperative correction of scoliotic curves by traction and casting improves the results achieved by operation. Use of the halo-hoop apparatus allows controlled correction when combined with spinal osteotomies. The anterior approach to the spine allows better correction and fusion of the more difficult curves of congenital scoliosis and those associated with neurofibromatosis and myelomeningocele.

Scoliosis in Marfanʼs syndrome. Its characteristics and results of treatment in thirty-five patients

Of sixty-four patients with Marfan's syndrome, thirty-five had scoliosis, which in 44 per cent began in the infantile and juvenile age periods. The curve patterns were double major right thoracic-left lumbar in 48 per cent and single right thoracic in 33 per cent. At the start of treatment the curves were severe (average, 72 degrees) and quite structural (average bending correction, 36 per cent). Seventy-four per cent of the thirty-five patients had back pain. Inadequately treated and untreated curves usually progressed to severe and painful deformity. Milwaukee brace treatment was generally unsuccessful because of the severity and rigidity of the curves or the poor maintenance of correction obtained. Spine fusion combined with Harrington rod instrumentation (fourteen patients) gave an average correction of 41 per cent with an average loss of 7 degrees (average follow-up, 2.3 years). Operative treatment of scoliosis is indicated in most patients with Marfan's syndrome.

Heterogenous transplant (Kiel bone) for the operative treatment of scoliosis.

Despite the relatively high incidence of defects found in the graft 6 months after the operation, we feel that this heterograft (Kiel bone) is a useful addition in the vertebral fusion operations.

The Milwaukee Brace in the Operative Treatment of Scoliosis

The Milwaukee Brace in the Operative Treatment of Scoliosis

The operative treatment of scoliosis

The operative treatment of scoliosis