Rigid Kyphosis Research Articles

Respiratory Synkinesis - Polyelectromyographic Investigation

From clinical observation we knew that thoracolumbar lordosis increases during deep (maximum) exhalation both standing and seated. We regularly made use of this effect for mobilization and self-treatment in patients with rigid thoracic kyphosis. From experience we also knew that with the patient prone, i.e. in thoracolumbar lordosis, the buttocks move up during deep exhalation and that during inhalation they move in a caudal direction. If cranial movement is resisted from above, effective traction results. In both situations the possible explanation was synkinetic contraction of the back muscles, in particular of the erector spinae.EMG examination of the back muscles was therefore carried out with the aid of surface electrodes in 30 subjects prone, with and without resistance against the cranial shift of the buttocks, and seated with the knees and the head pressed against crossed hands resting on the wall. Recordings were made at rest, during inhalation and during deep exhalation. In 12 subjects recording...

Point of View: Management of Rigid Post-traumatic Kyphosis

Point of View: Management of Rigid Post-traumatic Kyphosis

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)

Surgical Treatment of Neuropathic Spinal Arthropathy

Surgical treatment of neuropathic spinal arthropathy is traditionally associated with a high rate of complication. Ten patients were treated surgically using contemporary techniques of spinal instrumentation and fusion which included combined anterior and posterior procedures when appropriate. The etiology of the spinal arthropathy was fracture (8 patients) and tumor (2 patients). Mean postsurgical follow-up was 4 years. Solid arthrodesis was obtained in eight patients. Our recommendations for surgical treatment include (a) posterior segmental instrumentation and fusion for single level Charcot involvement, with bone grafting of the anterior single level defect accomplished through the posterolateral approach; (b) restoration of normal sagittal plane contour, with anterior first stage surgery recommended for rigid kyphosis or multiple level Charcot involvement; and (c) leaving no intercurrent unfused segments between new and old fusions in the area of neurologic deficit. Fusion to the pelvis is not always necessary but late arthropathy may develop between the fused segment and the pelvis.

Anterior Kostuik-Harrington Distraction Systems for the Treatment of Kyphotic Deformities

Based on the biomechanical principles of anterior distractive forces combined with instrumentation to decrease sagittal bending moments, an anterior system using a modification of Harrington instrumentation has been developed for the correction of kyphotic deformities. It has been used in the treatment of acute burst fractures in 100 cases, posttraumatic kyphosis in 45 cases, Scheuermann's kyphosis in 36 cases, rigid round backs in three cases, acute rigid kyphosis (congenital) in four cases, postlaminectomy in 21 cases, flat back syndrome in 56 cases, kyphosis secondary to tumor in ten cases, and kyphosis secondary to osteoporosis with fracture in four cases. A total of 279 cases have been treated with anterior instrumentation. Complications include breakage of 35 screws and four rods. There have been no early or late vascular or neurologic sequelae related to instrumentation. The biomechanical basis for the treatment of kyphotic deformities includes an anterior distractive force to resist compressive loads and, where possible, segmental fixation to decrease sagittal bending moments combined with bone grafts far from the neutral axis. This system provides these benefits with minimal risk and morbidity.

Lumbar spinal osteotomy.

1. The indications for correction of severe rigid kyphosis by lumbar osteotomy are described. 2. The fatal complications in a series of a hundred cases are listed. With more experience of this operation they should be considerably reduced. 3. Among the non-fatal complications the low incidence of recurrence of the deformity severe enough to require further operation is noteworthy.