Significant Scoliosis Research Articles

Transforaminal Endoscopic Decompression Alone Versus Limited Decompression/Fusion in the Treatment of Adult Degenerative Scoliosis: A Retrospective Study.

A retrospective study. To investigate and compare the clinical and radiographical outcomes of endoscopic decompression alone and limited decompression/fusion surgery in the treatment of adult degenerative scoliosis (ADS). Follow-up data of 53 patients with lower limb radiculopathy associated with ADS who underwent focal surgical treatment were collected (endoscope group: 31 patients treated by transforaminal endoscopic decompression alone; fusion group: 22 patients who underwent limited decompression/fusion). The following data were retrospectively analyzed and compared between the two group: the demographics, Lenke-Silva level, radiographic parameters, surgical data, visual analogue scale (VAS) for back/leg pain, the Oswestry disability index (ODI), and the modified MacNab criteria. The mean follow-up period was 15.68 ± 3.26 months. The most frequent Lenke-Silva level was I in the endoscope group, and III in the fusion group. Preoperative Cobb angle in the endoscope group was significantly lower than that in the fusion group (23.92 ± 9.06 vs 39.58 ± 13.12, P < 0.05). All patients exhibited improved VAS and ODI scores postoperatively (P < 0.05). At the last follow-up, the Cobb angle had progressed by 1.51° in the endoscope group, whereas radiographic parameters were significantly improved in the fusion group. The reoperation and complication rate in the endoscope group were lower than those in the fusion group. The satisfaction rate post-surgery was comparable between the two groups. For patients with focal ADS, both limited decompression/fusion and transforaminal endoscopic decompression are viable treatment options. Advanced transforaminal endoscopic techniques enable effective decompression of the symptomatic foramen with minimal complication risk and negligible deformity progression, even in cases of significant scoliosis. While limited fusion surgery can achieve comparable clinical outcomes, it offers inferior deformity correction.

Preoperative Echocardiogram Does Not Contribute to Surgical Risk Assessment in Patients With Large Curve Scoliosis and No Cardiac Risk Factors.

Severe scoliosis can affect thoracic organs, potentially leading to cardiovascular abnormalities. Thus, echocardiograms have been suggested for use in preoperative screening in patients with significant scoliosis. However, the utility of preoperative heart screenings in patients without known or suspected heart problems is not well understood. This study aims to find the incidence of cardiac findings in patients with severe scoliosis ≥90° without cardiac history. A single-institution retrospective chart review was performed. Inclusion criteria were scoliosis patients with curves ≥90 degrees and a screening echocardiogram performed within 6 months of spine surgery. Patients with a previous cardiac history, diagnosis associated with cardiac comorbidities (eg, connective tissue disease), or major coronal curves <90 degrees were excluded. Echocardiogram reports and perioperative clinical notes from involved services (including orthopaedics, cardiology, and anesthesia) were reviewed. Any postoperative use of vasopressors and reasons for their use were recorded. Overall, 50 patients met the inclusion criteria. The mean age at surgery was 14.0 ± 4.9 years old (range: 2 to 33). The mean major curve was 108 ± 19 degrees (range: 90 to 160 degrees). A normal echocardiogram was seen in 38 (76%), whereas 6 patients (12%) had mild dilation of the aortic sinus or root, 4 (8%) had mild valvular regurgitation, 1 patient had a small atrial septal defect, and 1 had a trace pericardial effusion. No patient had any changes made to their perioperative plan and one patient was advised to see a cardiologist postoperatively. Postoperatively, 8 patients (16%) received vasopressors to raise blood pressure to meet preset goal MAP, but only one of these 8 had a positive echocardiogram (mild valvular insufficiency), which was not seen as a contributing factor to the use of pressors. This study suggests that screening echocardiograms for patients without a cardiac history or related symptoms does not contribute to the evaluation of perioperative risk or anesthetic management. Creating clear, evidence-based guidelines for the utilization of perioperative testing, like echocardiograms, can reduce the social, time, and financial burdens on families. Such guidelines are vital for appropriate risk assessment and proper utilization of health care resources. Level III.

The relationship between hip displacement, scoliosis, and pelvic obliquity in 106 nonambulatory children with cerebral palsy: a longitudinal retrospective population-based study.

The relationship between hip displacement (HD), pelvic obliquity (PO), and scoliosis in nonambulatory children with cerebral palsy (CP) has not been clearly elucidated. The aims of this population-based study were to examine the prevalence and temporal sequence of these deformities in nonambulatory children with CP and to evaluate how probable it is that severe unilateral HD contributes to development of scoliosis. This longitudinal study comprised 106 nonambulatory children, enrolled in a surveillance program. Pelvic radiographs for measurements of migration percentage (MP) and PO were taken once a year from the diagnosis of HD. Spine radiographs were taken in patients with clinically detected scoliosis. Radiographic follow-up continued until skeletal maturity. Clinically significant scoliosis (Cobb angle ≥ 40°) occurred in 60 patients at a mean age of 11.8 years. 65 patients developed clinically significant HD (MP ≥ 40%) at a mean age of 4.8 years. 24 patients had no significant hip or spine deformities, 22 had HD only, 17 had scoliosis only, and 43 had both deformities. HD was diagnosed before scoliosis in all except 1 of the patients with both deformities. 14 of 19 patients with severe unilateral HD (MP ≥ 60%) had scoliosis convexity to the opposite side of the displaced hip. The combination of scoliosis and HD was frequent, and HD was diagnosed first in almost all the patients. HD might be a contributory cause of scoliosis in patients with severe, unilateral HD, PO, and later scoliosis with convexity to the opposite side.

Risks of Spinal Abnormalities and Growth Impairment After Radiation to the Spine in Childhood Cancer Survivors: A PENTEC Comprehensive Review

A PENTEC (Pediatric Normal Tissue Effects in the Clinic) review was performed to estimate the dose-volume effects of radiation therapy on spine deformities and growth impairment for patients who underwent radiation therapy as children. A systematic literature search was performed to identify published data for spine deformities and growth stunting. Data were extracted from 12 reports of children irradiated to the spine (N = 603 patients). The extracted data were analyzed to find associations between complication risks and the radiation dose (conventional fractionation throughout) as impacted by exposed volumes and age using the mixed-effects logistic regression model. When appropriate, corrections were made for radiation modality, namely orthovoltage beams. In the regression analysis, the association between vertebral dose and scoliosis rate was highly significant (P < .001). Additionally, young age at time of radiation was highly predictive of adverse outcomes. Clinically significant scoliosis can occur with doses ≥15 Gy to vertebrae during infancy (<2 years of age). For children irradiated at 2 to 6 years of age, overall scoliosis rates of any grade were >30% with doses >20 Gy; grade 2 or higher scoliosis was correlated with doses ≥30 Gy. Children >6 years of age remain at risk for scoliosis with doses >30 Gy; however, most cases will be mild. There are limited data regarding the effect of dose gradients across the spine on degree of scoliosis. The risk of clinically meaningful height loss was minimal when irradiating small volumes of the spine up to 20 Gy (eg, flank irradiation), except in infants who are more vulnerable to lower doses. Growth stunting was more frequent when larger segments of the spine (eg, the entire spine or craniospinal irradiation) were irradiated before puberty to doses >20 Gy. The effect was modest when patients were irradiated after puberty to doses >20 Gy. To reduce the risk of kyphoscoliosis and growth impairment, the dose to the spine should be kept to <20 Gy for children <6 years of age and to <10 to 15 Gy in infants. The number of vertebral bodies irradiated and dose gradients across the spine should also be limited when possible.

Upper instrumented vertebrae selection criteria for degenerative lumbar scoliosis based on the hounsfield unit asymmetry of the first coronal reverse vertebrae: an observational study

BackgroundSelection of the upper instrumented vertebra (UIV) is crucial for surgical treatment of degenerative lumbar scoliosis (DLS), given the relevance of UIV in postoperative proximal adjacent segment degeneration (pASD). Our previous research found that selection of UIV not lower than (≤) the first coronal reverse vertebra (FCRV), which marks the turning point of Hounsfield unit (HU) asymmetry, could significantly reduce pASD. However, the degree of HU asymmetry can vary among patients, suggesting a demand for more individualized UIV selection criteria, which we aimed to develop using quantitative HU measurement in the current study.MethodsWe included 153 consecutive patients with DLS. Quantitative measurement of HU of both sides of the vertebrae of these patients was performed on three planes of CT reconstruction for average values and determination of FCRV. Pre- and postoperative X-ray plain films were examined for radiological measurements and determination of pASD. Further, 35 patients with lumbar disc herniation and without significant scoliosis were also included as the reference group, and their bilateral HU was measured.ResultsIn all 153 patients, those with UIV ≤ FCRV had a significantly lower rate of pASD (9.4% vs. 24.6%, P = 0.011). The difference between HU of the left and right sides of the FCRV (dF) could range from close to 0–59.4. The difference between HU of the left and right sides of the vertebrae in the reference group had an average value of 5.21. In 101 dF ≥ 5 DLS patients, those with UIV ≤ FCRV had a significantly lower rate of pASD (7.6% vs. 28.6%, P = 0.005), while this rate was insignificant in the other 52 dF < 5 patients (13.3% vs. 18.2%, P = 0.708). No other general, radiological, or operative parameter was found to have significant influence on the occurrence of pASD.ConclusionsSelection of UIV ≤ FCRV can significantly reduce the risk of pASD for patients with DLS with dF ≥ 5.Trial Registration Not applicable, since this is an observational study.

ОПИСАНИЕ СЕРИИ КЛИНИЧЕСКИХ НАБЛЮДЕНИЙ ТОРАКОСКОПИЧЕСКОГО ЛЕЧЕНИЯ ВРОЖДЕННЫХ ИЗОЛИРОВАННЫХ ТРАХЕОПИЩЕВОДНЫХ СВИЩЕЙ Н-ТИПА У МЛАДЕНЦЕВ

Isolated H-type tracheoesophageal fistula is a rare anomaly of the respiratory tract which accounts for 4% of all malformations of the trachea and esophagus. Authors report patients with this developmental anomaly who underwent fistula dissection by the same single surgeon and at different surgical facilities with particular emphasis on preoperative diagnosis and treatment. Thoracoscopic transsection of H-type tracheoesophageal fistula was performed by a single surgeon in 5 patients (3 boys and 2 girls) with R. Gross congenital isolated type E fistulas who were admitted at 2 to 12 weeks of age. The patients were in three surgical facilities located in the cities of Irkutsk and Tomsk (both - Russia), Tashkent (Republic of Uzbekistan). In the final part the methods of preoperative examination, the parameters of the surgical intervention and the results of postoperative observation are given. All 5 procedures were successfully performed thoracoscopically without conversion into open intervention. The duration of the surgical intervention varied from 45 to 135 minutes. The average intervention period was 78.0±35.8 minutes (median - 60.0 [52.5; 112.5] minutes). The mean duration of mechanical ventilation in this group was 33.6±10.0 hours (median - 36.0 [24.0; 42.0] hours) with the longest interval being 48 hours in a patient with pre-existing respiratory distress. The exact time range to complete oral nutrition has been well documented and ranged from 5 to 8 days. Esophageal and tracheal suture failure was not recorded in patients with H-type tracheoesophageal fistula. Two patients required Nissen surgery for hiatal hernia at 6 months and 1 year after initial H-type tracheoesophageal fistula ligation. All patients are currently on full oral nutrition. The follow-up period in this group ranged from 12 to 60 months. These patients showed no signs of recurrence of the fistula. Patients were evaluated for vocal cord paresis if clinical stridor was observed postoperatively. However, no recurrent nerve injury was found in any of the patients in this series of cases. Authors did not record signs of chest asymmetry, pterygoid scapula, laxity of the shoulder girdle or clinically significant scoliosis. Thoracoscopy allows direct visualization and dissection of an H-type tracheoesophageal fistula. Authors believe this technique allows achieving better mobilization of the posterior mediastinal organs than in thoracotomy, which probably expands the scope of thoracoscopic access in the treatment of this disease.

Analysis of characteristic features in ultrasound diagnosis of fetal limb body wall complex during 11-13+6 weeks.

Limb body wall complex (LBWC) is a fatal malformation characterized by major defects in the fetal abdominal or thoracic wall, visceral herniation, significant scoliosis or spina bifida, limb deformities, craniofacial deformities, and umbilical cord abnormalities (short or absent umbilical cord). Early diagnosis of this condition is of great clinical significance for clinical intervention and pregnancy decision-making. With the rapid development of fetal ultrasound medicine, early pregnancy (11-13+6 wk) standardized prenatal ultrasound examinations have been widely promoted and applied. To explore the value of prenatal ultrasound in the diagnosis of fetal LBWC syndrome during early pregnancy. The ultrasonographic data and follow-up results of 18 cases of fetal LBWC diagnosed by prenatal ultrasound during early pregnancy (11-13+6 wk) were retrospectively analyzed, and their ultrasonographic characteristics were analyzed. Among the 18 fetuses with limb wall abnormalities, there were spinal dysplasia (18/18, 100%), varying degrees of thoracoschisis and gastroschisis (18/18, 100%), limb dysplasia in 6 cases (6/18, 33%), craniocerebral malformations in 4 cases (4/18, 22%), thickening of the transparent layer of the neck in 5 cases (5/18, 28%), and umbilical cord abnormalities in 18 cases (18/18, 100%), single umbilical artery in 5 cases. Prenatal ultrasound in early pregnancy can detect LBWC as early as possible, and correct prenatal evaluation provides important guidance value for pregnancy decision-making and early intervention.

PA15 Becker naevus syndrome associated with a mosaic pathogenic variant in ACTB

Abstract A 15-year-old girl presented with an 8-year history of a gradually enlarging, irregular, nonconfluent hyperpigmented patch on her left flank. The lesion demonstrated an area of increased hair growth, did not cross the midline and was mildly pruritic but otherwise asymptomatic. Another pigmented patch, present since birth, was also noted on her right lower back and was consistent with a café-au-lait macule. Medical history included a marfanoid phenotype with musculoskeletal complications including scoliosis and joint hypermobility, for which she was under the care of the orthopaedic team for bilateral patellar instability associated with recurrent dislocation. She was also noted to have increased skin laxity, mild pectus excavatum, mitral valve prolapse and symptomatic tachyarrhythmias. She was born at term, to nonconsanguineous parents, with no postnatal developmental concerns. There was a family history of an older brother with significant scoliosis and hip dysplasia requiring hip replacements, developing from the age of 14 years. Genetic testing was negative for FBN1 and five other genes associated with Marfan syndrome. Thyroid function and bone profile were normal. Menarche occurred at 11 years of age, and a full hormone profile was normal except for a mildly raised prolactin level, deemed to be a normal variant in puberty. Abdominal and pelvic ultrasounds were normal. Skin biopsy from the left flank revealed orthokeratosis, irregular elongation of rete ridges and sparse perivascular chronic inflammation in the superficial dermis. Next-generation sequencing and droplet digital polymerase chain reaction from DNA extracted from skin revealed de novo mosaic pathogenic variants in ACTB, which encodes β-actin, an intracellular protein involved in cell migration, signalling and proliferation. Recurrent mosaic variants in ACTB have previously been associated with 61% of Becker naevi and one case of Becker naevus syndrome in one study (Cai ED, Sun BK, Chian A et al. Postzygotic mutations in beta-actin are associated with Becker’s nevus and Becker’s Nevus syndrome. J Invest Dermatol 2017; 137:1795–8), as well as congenital smooth muscle hamartomas and odontomaxillary dysplasia. Our patient had cutaneous and extracutaneous features suggestive of Becker naevus syndrome. This rare syndrome predominantly involves skeletal and soft tissue abnormalities, with breast hypoplasia most frequently reported. Notable features here include a café-au-lait macule, scoliosis and pectus excavatum. This case highlights the value of DNA analysis from skin in confirming a diagnosis, after 9 years of presentation to paediatric services. Given the heterogeneous extracutaneous phenotypes, there are also important implications for counselling and screening of associated conditions.

Early Development of Spinal Deformities in Children Severely Affected with Spinal Muscular Atrophy after Gene Therapy with Onasemnogene Abeparvovec-Preliminary Results.

Spinal muscular atrophy (SMA) is a rare genetic disorder, with the most common form being 5q SMA. Survival of children with severe SMA is poor, yet major advances have been made in recent years in pharmaceutical treatment, such as gene-therapy, which has improved patient survival. Therefore, clinical problems, such as the development of spinal deformities in these genetically treated SMA children represent an unknown challenge in clinical work. In a retrospective case series, the development of spinal deformities was analyzed in 16 SMA children (9 male, 7 female) treated with onasemnogene abeparvovec in two institutions during the years 2020 to 2022. Ten out of sixteen patients had a significant kyphosis, and nine out of sixteen patients had significant scoliosis, with the mean curvature angles of 24 ± 27° for scoliosis, and 69 ± 15° for kyphosis. Based on these preliminary data, it can be assumed that early-onset kyphosis presents a clinical challenge in gene-therapy-treated SMA children. Larger datasets with longer follow-up times need to be collected in order to verify these preliminary observations.

Comparison of scoliosis diagnostic capabilities in screening of schoolchildren by computer optical topography and video rasterstereography using TODP and Formetric topographs

Objective. To analyze the results of scoliosis diagnostics during the examination of the same group of schoolchildren by TODP and Formetriс topographs.Material and Methods. A total of 364 schoolchildren (197 girls and 167 boys, mean age 8.92 ± 1.9 years) were examined, divided into 3 age groups: 6–8 years old (n = 135, mean age 7.22 ± 0.7 years), 8–10 years old (n = 134 children, mean age 8.95 ± 0.56 years), 10–12 years old (n = 95 children, mean age 11.35 ± 1.59 years). Schoolchildren were examined in turn by computer optical topography (TODP, released in 2021, WTOPO 5.4-2021 software) and video raster stereography (Formetric 4D released in 2015, DICAM2.6.4 software). Three standard screening poses were used for TODP, and one pose with averaging 12 frames – for Formetric.Results. The obtained statistics on the distribution of topographic analogs of the Cobb angle (the angle of lateral asymmetry for TODP and the angle of scoliosis for Formetric) showed a significant discrepancy in the percentage of detected scoliosis cases: 0–5° – 50,0 % (TODP) and 4.1 % (Formetric); 5–7° – 33.8 % and 9.3 %; 7–9° – 12.4 % and 17.9 %; 9–15° – 3.8 % and 51.6 %; 15–25° – 0,0 % and 16.2 %; 25–50° – 0,0 % and 0.8 %, respectively. Clinically significant cases of scoliosis (9° or more) in the age groups was 3.7 %, 2.2 %, 6.6 % (mean – 3.8 %) for TODP and 71.1 %, 70.1 %, 63.2 % (average – 68.7 %) for Formetric. At the same time, only 14 cases of clinically significant scoliosis (from 9° to 15°), including 9 structural and 5 compensatory scoliosis, were detected by TODP, and 250 scoliosis cases (188 – from 9° to 15°, 59 – from 15° to 25°, 3 – from 25° to 37°) – by Formetric. For 9 structural scoliosis cases (according to TODP), the Formetric diagnosis coincided completely only in 2 cases and partially in 3 (55 %), and in 5 cases of compensatory scoliosis (according to TODP) it coincided completely in 3 cases and partially in 1 (80 %).Conclusion. According to the results of topographic screening of 364 schoolchildren using the TODP topograph, 3.8 % of scoliosis cases of 9° or more was detected, which corresponds to the average screening data in a number of countries around the world. Examination of the same schoolchildren using the Formetric topograph revealed 68.7 % of cases of scoliosis of 9° or more, which allows us to judge about overdiagnosis and conclude that Formetric is poorly suited for topographic screening of scoliosis in schoolchildren.

The better can be the enemy of the good. Pericardial effusion after upgrading from single- to dual chamber pacemaker. Conservative treatment

We introduce the case of 88-year-old woman with multiple comorbidities including severe aortic stenosis and significant scoliosis. In the third-degree atrioventricular block at sinus rhythm, a single-chamber pacemaker was initially implanted. 15 months after the first procedure upgrading to a dual chamber pacemaker was performed, which was complicated by pericardial effusion. It resolved spontaneously, but after 2 weeks it occurred again. Conservative treatment with ibuprofen and colchicine led to resorption of the pericardial effusion.

New insights in the prevalence of scoliosis and musculoskeletal asymmetries in adolescents with esophageal atresia

BackgroundIncreased risk of scoliosis and musculoskeletal abnormalities in adolescents with esophageal atresia (EA) is reported, but the impact of these abnormalities on physical fitness and motor skills are not known. MethodsScoliosis was assessed radiographically and shoulder and chest abnormalities by a standardized protocol. Physical fitness was evaluated with Grippit, Six-minute walk test, and International Physical Activity Questionnaire and motor skills by Motor Assessment Battery for Children. ResultsSixty-seven EA adolescents median 16 (13–20) years participated. The prevalence of significant scoliosis (≥ 20º) was 12% (8/67) whereas 22% (15/67) had mild scoliosis (10–19º). Vertebral anomalies occurred in 18/67 (27%), eight of them (44%) had scoliosis. The majority of adolescents (15/23) with scoliosis did not have vertebral anomalies. Musculoskeletal abnormalities were detected in 22–78%. Balance problems occurred three times more frequently than expected (44% vs. 15%, p = 0.004). Submaximal exercise capacity was significantly reduced compared to reference values (p < 0.001). Scoliosis ≥ 20º was related to reduced physical activity (p = 0.008), and musculoskeletal abnormalities to reduced physical activity and impaired motor skills (p = 0.042 and p < 0.038, respectively). ConclusionsSignificant scoliosis was diagnosed in 12% of the EA adolescents and related to reduced physical activity. Musculoskeletal abnormalities identified in more than half of the patients, were related to reduced physical activity and impaired motor skills, and exercise capacity was significantly below reference group. EA patients with and without vertebral anomalies need health-promoting guidance to prevent impaired motor skills and consequences of reduced physical activity.Level of evidence: Prognostic Study, Level II

Navigated retrodiaphragmatic/retroperitoneal approach for the treatment of symptomatic kyphoscoliosis: an operative video.

Retropleural, retrodiaphragmatic, and retroperitoneal approaches are utilized to access difficult thoracolumbar junction (T10–L2) pathology. The authors present a 58-year-old man with chronic low-back pain who failed years of conservative therapy. Preoperative radiographs demonstrated significant levoconvex scoliosis with coronal and sagittal imbalance. He underwent a retrodiaphragmatic/retroperitoneal approach for T12–L1, L1–2, L2–3, and L3–4 interbody release and fusion in conjunction with second-stage facet osteotomies, L4–5 TLIF, and T10–iliac posterior instrumented fusion. This video focuses on the retrodiaphragmatic approach assisted by 3D navigation.The video can be found here: https://stream.cadmore.media/r10.3171/2022.3.FOCVID2215

Scoliosis in Spinal Muscular Atrophy Type 1 in the Nusinersen Era.

The introduction of spinal muscular dystrophy (SMA)-modifying therapies, such as antisense oligonucleotide therapy, has changed the natural history of SMA. Most reports on treatment outcomes have focused on motor scores and respiratory function. The objective of this study is to document the development and progression of scoliosis in patients with SMA1 treated with nusinersen. A descriptive single-center study was conducted in patients with SMA1 who were treated with nusinersen before 6 months of age. Data were collected on patients who met criteria, including age at the first nusinersen dose, number of nusinersen doses, degree of scoliosis, respiratory parameters, feeding route, and motor scores at baseline and follow-up. The Children's Hospital of Philadelphia Infant Test of Neuromuscular Disorders (CHOP-INTEND) was subanalyzed using axial (AxS) and appendicular motor (ApS) scores to evaluate a possible correlation between scoliosis and axial muscle strength. From our cohort, 31 percent (11/35) of patients had a diagnosis of SMA1. Sixty-three percent (7/11) met the inclusion criteria. All patients (7/7) showed initial improvement in their CHOP-INTEND scores in correlation with improvement on the ApS. Despite this, most patients did not show improvement in the AxS. Subsequently, all patients developed scoliosis in the first year of life with Cobb angles that ranged between 18° and 60°. Furthermore, total CHOP-INTEND scores had dropped in 2 patients alongside the development of a Cobb angle of >40°. Despite the significant improvement in functional motor assessment in patients with SMA1, there is a progression of significant scoliosis despite treatment. Subsequently, lack or minimal improvement on the axial CHOP-INTEND scores may predict worsening on the total motor scores.

Scoliosis in dysplastic spondylolisthesis: a clinical survey of 50 young patients

BackgroundDysplastic spondylolisthesis is a rare spinal deformity that occurs mainly in young patients. Although its sagittal parameters had been well stated, coronal abnormalities in these patients were poorly studied. The purposes of this study were: (1) to investigate the prevalence of scoliosis in dysplastic spondylolisthesis;(2) to assess scoliosis resolution or persistence after surgery; and (3) to propose a modified classification of scoliosis associated with dysplastic spondylolisthesis.MethodsFifty patients (average age 14.9 ± 5.6 years) diagnosed with dysplastic spondylolisthesis who underwent surgical treatment were followed up and their data were analyzed. Standing posteroanterior and lateral full spine radiographs were used to measure the coronal and sagittal parameters. Patients with scoliosis, which was defined as a coronal Cobb angle greater than 10°, were divided into three groups according to their curve characteristics: “independent” scoliosis (IS) group, spasm scoliosis (SS) group, and olisthetic scoliosis (OS) group. SS and OS were spondylolisthesis-induced scoliosis. The radiographic parameters and patient-reported outcomes were collected before and after surgery and compared between groups.ResultsThe average slip percentage was 62.8% ± 23.1% and the average follow-up time was 51.5 ± 36.4 months (range 3–168 months). Twenty-eight of the 50 (56%) dysplastic spondylolisthesis patients showed scoliosis, of which 8 were IS (24.7° ± 15.2°), 11 were SS (13.9° ± 3.0°), and 9 were OS (12.9° ± 1.9°). By the last follow-up, no scoliosis resolution was observed in the IS group whereas all SS patients were relieved. Of the nine patients with OS, four (44.4%) had scoliosis resolution after surgery.ConclusionDistinguishing different types of scoliosis in dysplastic spondylolisthesis patients may help surgeons to plan treatment and understand prognosis. For patients with significant scoliosis, whether “independent” or spondylolisthesis-induced, treatment of spondylolisthesis should be performed first and scoliosis should be observed for a period of time and treated according to the corresponding principles.

Selective Thoracic Fusion for Idiopathic Scoliosis: A Comparison of Three Surgical Techniques with Minimum 5-year Follow-up.

Single-center retrospective review of outcomes among three surgical techniques in the treatment of thoracic idiopathic scoliosis (T-AIS) with a follow-up of at least 5 years. To investigate how outcomes compare in video-assisted anterior thoracic instrumentation (VATS), all hooks/hook-pedicle screw hybrid instrumentation (HHF), and all pedicle screw instrumentation (PSF) techniques for T-AIS. Studies comparing outcomes for anterior versus posterior fusion for T-AIS are few and with short follow-up. Three groups of patients with T-AIS who underwent thoracic fusion were included in this study: 98 patients with mean curve of 49.0° ± 9.5° underwent VATS (Group 1); 44 patients with mean curve of 51.1° ± 7.4° underwent HHF (Group 2); and 47 patients with mean curve of 47.6° ± 9.9° underwent PSF (Group 3). Radiological outcomes were compared at preoperative, and up to 5 years. Surgical outcomes were noted until latest follow-up. Group 1 had less blood loss, less fusion levels, longer surgical time, and longer hospital stay compared with the other groups (P < 0.01). Groups 1 and 3 were comparable in all time periods with 78.8% and 78.2% immediate curve correction, and 72.9% and 72.1% at 5 years, respectively. Group 2 had lower correction in all time periods (P < 0.0001). Thoracic kyphosis and lumbar lordosis decreased in Group 3, but improved in both Groups 1 and 2 (P < 0.0001). Group 1 had more respiratory complications. The posterior groups had more deep wound infections. Two patients in Group 1 and one patient in Group 2 required revision surgery for implant-related complications. Reoperations for deep wound infections were noted only in the posterior groups. This is the first report comparing 5 year outcomes between anterior and posterior surgery for T-AIS. All three surgical methods resulted in significant and durable scoliosis correction; however, curve correction using HHF was inferior to both VATS and PSF with the latter two groups achieving similar coronal correction. However, VATS involved fewer segments, kyphosis improvement, and no deep wound infection, whereas PSF has less surgical time, shorter hospital stays, and no revision surgery from implant-related complications.Level of Evidence: 3.

Frequency of Musculoskeletal Disorders in Non-Cystic Fibrosis Bronchiectasis Patients: Cross Sectional Study

Background: Non-cystic fibrosis bronchiectasis (non-CF BE) is a common chronic lung disease thus causing high morbidity among adults. Aim: To investigate the frequency of musculoskeletal disorders in non-cystic fibrosis bronchiectasis among patients. Study Design: Cross sectional study. Methodology: Patients having non-cystic fibrosis bronchiectasis were included in present study through non-probability, convenient sampling technique. Nordic musculoskeletal questionnaire (NMQ) was used to study prevalence of Musculoskeletal Disorders. Patients of both sexes having age (18-40 yrs) were included. Patients having any disease like cystic fibrosis bronchiectasis, active neurological disorder, mental disorders and significant scoliosis or kyphosis were excluded. Data analyzed by SPSS 25.0v. Results: There are 37(24.3%) male and 115(75.7%) females in the present study. Almost 38.8% patients changed their profession while 88.2% were prevented from working due to musculoskeletal disorder during last 1 year. Around 83.6% patients had pain in lower back with knee pain, 27.6% had ankle pain, 34.2% had hip pain, while 57.2% had upper back pain during last 1 year. Conclusion: This study concluded that non-cystic fibrosis bronchiectasis patients had a high frequency of reported musculoskeletal disorders like 83.6% have lower back pain with knee pain. Thus frequency was high for low back pain as musculoskeletal disorder among enrolled subjects. Keywords: Frequency, Musculoskeletal Disorders and Bronchiectasis.

Dorsal intramedullary giant dermoid tumor

Intramedullary dermoid tumors are rare benign neoplasms that correspond to 1 to 2% of all intramedullary tumors, affecting specially the lumbosacral region. Those tumors are composed of remnants of embryonic tissue derived from the ectoderm, whose walls secretions cause slow growth rate. Despite its benign character, neurological injury comes from the tumor's expansive process and the collateral damage derived from the complete resection of the cyst wall, which can cause hypoesthesia and radicular pain, besides other effects as neuromuscular scoliosis. The primary treatment for intramedullary tumor is resection surgery. The case reported involves an infant with an extensive dorsal intramedullary dermoid tumor without association with spinal dysraphism, presenting clinically complete paraplegia, lower limbs atrophy, hypoesthesia from the T4 level and urinary incontinence. The physical examination revealed upper motor neuron syndrome in the lower limbs, mild cognitive delay and a significant scoliosis. Image exams showed a Cobb angle from T3 to L2 with 115º sitting and 68º with traction, besides a massive expansive intramedullary formation extending from C5 to the T9 plane. The patient underwent extensive cervical and thoracic laminotomy followed by median myelotomy and the resection of the lesion. An arthrodesis treated the secondary vertebral deformity. The postoperative period showed good surgical recovery and the control exams revealed ample resection of the lesion and adequate control of scoliosis with partial maintenance of rotational deformity.&#x0D;

A successful transcatheter aortic valve implantation in an extremely tortuous S-shaped aorta due to chest deformation.

A 65-year-old woman was admitted to the hospital for interventional treatment of aortic stenosis. Echocardiography confirmed severe aortic stenosis and a normal left ventricular ejection fraction (60%). Computed tomography demonstrated an extremely tortuous, S-shaped descending aorta and a significant scoliosis with chest wall deformation (Figs. 1A, B). Considering the complex anatomy, the Heart Team qualified the patient for transcatheter aortic valve implantation (TAVI), despite the low peri-operative risk (1.54% in the EuroScore II). Transcatheter aortic valve implantation was performed in a standard manner, under local anesthesia, from the right femoral artery. Once the Confida Brecker Curve guidewire was placed in the aortic arch, the valve was predilated with 20 mm balloon. A 26 mm Evolut PRO valve (Medtronic Inc., Minneapolis, Minnesota) was slowly advanced into the aorta, which was techni cally challenging (Fig. 1C, Suppl. Video 1). The valve was correctly aligned and deployed under rapid pacing (120/min). Aortogram at the end of the procedure showed no evidence of aortic injury or paravalvular leak (Fig. 1D). Procedural success was confirmed by control transthoracic echocardiography. The indications for transfemoral TAVI are expanding. The final decision considering the type of procedure should be made by the Heart Team, based on an individual’s evaluation. Despite the low risk of mortality following surgery, the patient suffered from the extreme chest wall deformation which made successful sternotomy and latter rehabilitation improbable. Given the flexibility of second generation TAVI delivery systems, it is possible to safely perform the procedure even in a severely tortuous anatomy, which was initially considered a contraindication for TAVI.

P.140 Emergency caesarean section for a parturient in acute respiratory distress due to COVID-19

Introduction: Studies in the early pandemic have shown that 1 in 10 pregnant women admitted to hospital in UK with SARS- Cov 2 infection needed respiratory support.[1]Knight M, Bunch K, Vousden N, et al. Characteristics and outcomes of pregnant women admitted to hospital with confirmed SARS-COV- 2 infection in UK: national population based cohort study. BMJ 2020 :369;m2107Google Scholar The risk is increased with other co-morbidities. Hence multi-disciplinary decision making and timely delivery are crucial. We describe the anaesthetic management of an emergency caesarean section (CS) of a morbidly obese parturient with cerebral palsy and TRAPS (Tumor necrosis factor receptor associated periodic syndrome) who presented with respiratory distress during the third trimester. Case Report: A 34-year-old woman booked for an elective CS was admitted with a 2-day history of increasing shortness of breath and fever at 33 weeks. She had tested positive for Covid-19, 9 days previously. She had a background history of cerebral palsy, a raised BMI of 46 kg/m 2and a genetic disorder TRAPS. She was also known to be difficult for lumbar puncture. On admission her respiratory rate was 40 breaths/min and her saturation 94% on 2 L/min of oxygen. She was started on co-amoxiclav and hydrocortisone. A multidisciplinary decision involving physicians, obstetricians, an intensivist and anaesthetist was to deliver if her condition worsened to facilitate maternal stabilisation. Her condition deteriorated overnight with increasing oxygen requirement to maintain saturation 94%. and PO2 of 8 kPa. The decision was made to deliver her the following morning. Dexamethasone and magnesium sulphate were administered for fetal lung maturation and brain protection. The anaesthetic technique was a single-shot spinal. Standard monitoring was used in theatre. Lumbar puncture in the sitting position at L3-4 was successful at second attempt. 0.5% hyperbaric bupivacaine 2.3 mL with diamorphine 250 μg was administered. Nasal Optiflow was available in case of significant hypoxia. Cardiovascular stability was maintained with a phenylephrine infusion. Maternal saturation was maintained at 94% with facemask oxygen at 8 L/min. She tolerated the supine position on an Oxford pillow for the duration of operation. The baby was delivered in good condition. Post-operatively, she was transferred to the high dependency unit where she required high-flow nasal oxygen with AIRVO2 50 L/min She was treated with remdesivir for 5 days and dexamethasone for 10 days. She responded to treatment and was stepped down to the ward after 5 days. Discussion: Covid-19 infection in a high-risk pregnancy can result in severe respiratory failure requiring ventilatory support. Multidisciplinary care is essential for management of such cases as timely delivery is essential to provide optimal ventilatory strategy for the mother. Non-invasive ventilation may be beneficial to patients in the initial phase and may prevent deterioration. Our aim was to avoid general anaesthesia. Spinal was preferred over CSE to minimise the time to administer block as patient has history of difficult lumbar puncture, difficulty in sitting up even with support due to cerebral palsy and significant scoliosis.