Spinal Column Deformity Research Articles

ID: 206203 Management Pathway and Outcomes of Spinal Cord Stimulation for Patients With Spine Deformities

Spinal column deformities such as kyphosis or rotoscoliosis are typically managed surgically with major spinal deformity correction procedures, which are associated with substantial immediate and delayed complication rates. In some patients, associated medical co-morbidity may preclude a deformity correction procedure.

First abnormalities investigation in Mullus barbatus (Mullidae) from the Eastern Coast of Algeria

Red mullet Mullus barbatus, Linnaeus, 1758, is a benthic marine fish. Because of its wide geographic distribution and close association with sediments, red mullet is commonly used as a sentinel species for pollution assessment along the Mediterranean coast. A total of 500 specimens were examined from the Gulf of Bejaia, eastern coast of Algeria, from June 2018 to June 2019 by X-ray radiography and histopathological examination. We observed for the first time in Algeria complex spinal column deformities (kyphosis, lordosis, and scoliosis), vertebral coalescence, vertebral fusion, missing of one pelvic fin, caudal fin abnormalities, congested cheek, lymphocystis, ovary malformation, and asymmetric testis. Additionally, fibrosis, inflammatory reaction, melano-macrophage centres, necrosis, atresia, and disturbance of normal tissue were detected by histopathology examination

Digital models and tools for diagnosing three-dimensional spinal deformity based on stereophotogrammetry data

Scoliosis is the most common orthopedic disease in children, which most often leads to disability. An urgent task of the current stage of the development of spinal deformity diagnostics is the search and introduction of new available methods of non-invasive safe diagnosis of spinal deformity at early stages, since existing diagnostic methods can detect spinal column deformity in three planes during the development of scoliosis, however, they have a number of limitations for use, since either X-ray radiation or diagnostic installations are used for their implementation, requiring complex installation in a separate room and training of operating personnel. In this regard, there is an urgent need to develop digital tools for the diagnosis of spinal deformity, which would neutralize these difficulties in clinical practice. The aim of the study was to develop a mathematical algorithm for identifying the deformation of the spinal column in the horizontal plane according to the photogrammetric evaluation of a three-dimensional model of the surface of the human back, which was obtained from the results of the operation of the original software for a personal telecommunications device. The algorithm for assessing spinal column deformity is a sequence of four stages: reposition of the coordinate system, stratification of the spine line into segments, calculation of the rotation of V-segments, separation of the V-segment ratios to the physiological bends of the spine and visualization of spinal deformity in the horizontal plane. The developed algorithm has a number of advantages compared to those developed earlier: it allows to identify the rotation of individual vertebrae and torsion of the spine as a whole, is implemented in relation to all vertebrae of the thoracic and lumbar spine, thereby providing the possibility of differentiated diagnosis of forms of spinal deformity - from posture disorders to scoliosis. The described algorithm is a separate part for modular software that allows diagnostics of spinal column deformity using a personal telecommunication device. This algorithm can be used in a comprehensive assessment of posture disorders and scoliosis, monitoring the dynamics of spinal column deformity in the rehabilitation process.

Effectiveness of Prophylactic Ephedrine vs Fluid Preload in Prevention of Hypotension in Spinal Anesthesia for C-Section

Background: Hypotension following spinal block can be reduced or minimized prophylactically left lateral uterine displacement, volume loading with crystalloid solutions, phenylephrine infusion or ephedrine administration. Fluid pre loading does not negate the hypotension entirely but decreases the risk. This however is time consuming and vasopressors are often required to correct associated hypotension. Prophylactic ephedrine administration lowers the risk of hypotension at the expense of reactive hypertension if spinal block fails and subsequent conversion to general anesthesia. Aim: To compare the efficacy of prophylactic use of ephedrine versus fluid (Hartmann’s solution) preload in women undergoing cesarean section under spinal anesthesia at a teaching hospital. Study design: Randomized controlled trial. Place and duration of study: Department of Anesthesiology, Nishtar Hospital Multan, from 1st March 2020 to 30th September 2020. Methodology: A total of 100 women, twenty to forty years of age undergoing cesarean section were included. Patients with known hypertension, eclampsia, bleeding diathesis, injection site infection, deformity of spinal column or patients having valvular heart diseases were excluded. Group A women were given prophylactic ephedrine while Group B were given fluid (Hartmann’s solution) preload. After induction of spinal anesthesia continuous blood pressure monitoring was done for fifteen minutes to diagnose hypotension. Hypotension was noted and recorded by the researcher. Results: The mean age of women in group A was 28.04±6.07 years and in group B was 28.26±6.13 years. Majority of the patients, 56, were between twenty to thirty years of age. The mean BMI in group A was 29.06±3.37kg/m2 and in group B was 29.38±3.50 kg/m2. Efficacy of prophylactic use of ephedrine to prevent hypotension was observed in 37(74%) patients and in 25(50%) patients in fluid preload group undergoing cesarean sections under spinal anesthesia. Conclusion: The frequency of hypotension is lower in parturient undergoing spinal anesthesia with prophylactic use of ephedrine as compared to women having fluid (Hartmann’s solution) preload. Keywords: Spinal anesthesia, Hypotension, Ephedrine

The sequelae of a neglected thoracolumbar cystic spinal lesion

Large thoracolumbar intradural cystic lesions are rare. The possible diagnosis would be a cystic nerve sheath tumour, dural ectasia or arachnoid cyst. We report the first case of a neglected giant thoracolumbar spinal cystic tumour that had resulted in progressive deleterious spinal column deformity due to bony erosion precluding any form of surgical remedy. In the same case, another fatal sequela of a neglected spinal cystic tumour is a spontaneous rupture resulting in an acute hydrocephalus and mortality. This case impresses the natural history of a spinal cystic lesion. The take home point would be these cases need early surgical intervention is indicated to prevent sequelae that has been described.

Composite Enhancement Polyether-Ether-Ketone for Long Segmental Spinal Column Deformity Orthopedic Treatment

Polyether-ether-ketone (PEEK) anterior intervertebral fusion combined with posterior long segment orthopedic surgery is a common method for the therapy of orthopedic deformity of the spine. PEEK material plays an important role in the effect of surgery. Graphene on copper substrate was transferred to the surface of carbon-fiber reinforced polyether-ether-ketone (CFR-PEEK) material by ferric chloride (FeCl3) chemical erosion and physical adsorption, hence the compound enhancement polyether-ether-ketone (Ge-PEEK) was achieved. In terms of characterization, Raman spectrometer was used to analyze the characteristics of the product generation, the scanning electron microscope (SEM) was used to analyze the morphology of the product, and the hydrophilicity of the material was analyzed by the droplet contact Angle. From the perspective of intervertebral fusion, Ge-PEEK material was used in the intervertebral fusion device to analyze the effect of the fusion device in the correction of spinal deformity, such as displacement, convex Angle, and collapse. In the characterization test, Raman spectrum analysis showed that Ge-PEEK material had the characteristic peaks of graphene, and SEM analysis showed that CFR-PEEK material was covered on a large scale by graphene. In the droplet contact angle test, the contact angle of the graphene-modified CFR-PEEK material was significantly reduced (P < 0.05). The material had good hydrophilicity. In the analysis of lumbar interfusion, the anterior intervertebral fusion rate based on Ge-PEEK material was 95.8% (P < 0.05), and the vertebral deposition rate based on Ge-PEEK fusion device was 7.2% (P < 0.05). At the same time, the distance between the leading edge of the cone after operation and the last follow-up was compared, and it was found that the displacement distance of different segments was smaller (P < 0.05). This study proved that the proposed Ge-PEEK material was feasible for anterior intervertebral fusion in the correction of long-segment spinal deformity.

Severe Spinal Column Deformity from Scoliosis with Harrington Rods Implant

Severe Spinal Column Deformity from Scoliosis with Harrington Rods Implant

Epidemiological Study of Thoracolumbar Pott’s Spine at a Tertiary Care Hospital in North India

Abstract The vertebral column is involved in less than 1% of all the cases of tuberculosis. It can associated with major neurological deficits due to compression of adjacent neural structures with significant deformity of spinal column. Therefore, early diagnosis and management of spinal TB has special importance in preventing these serious complications. In order to extract current trends in diagnosis and medical or surgical treatment of spinal TB we performed a review with patients admitted to our hospital between 2016 and 2017. Although the development of more accurate imaging modalities such as magnetic resonance imaging and advanced surgical techniques have made the early diagnosis and management of spinal TB much easier, these are still very challenging topics. In this review we aim to discuss the diagnosis and management of spinal TB based on studies with acceptable design, clearly explained results and justifiable conclusions.

Involvement of the Spinal Cord in Mitochondrial Disorders.

This review aims at summarising and discussing the current status concerning the clinical presentation, pathogenesis, diagnosis, and treatment of spinal cord affection in mitochondrial disorders (MIDs). A literature search using the database Pubmed was carried out by application of appropriate search terms and their combinations. Involvement of the spinal cord in MIDs is more frequent than anticipated. It occurs in specific and non-specific MIDs. Among the specific MIDs it has been most frequently described in LBSL, LS, MERRF, KSS, IOSCA, MIRAS, and PCH and only rarely in MELAS, CPEO, and LHON. Clinically, spinal cord involvement manifests as monoparesis, paraparesis, quadruparesis, sensory disturbances, hypotonia, spasticity, urinary or defecation dysfunction, spinal column deformities, or as transverse syndrome. Diagnosing spinal cord involvement in MIDs requires a thoroughly taken history, clinical exam, and imaging studies. Additionally, transcranial magnetic stimulation, somato-sensory-evoked potentials, and cerebro-spinal fluid can be supportive. Treatment is generally not at variance compared to the underlying MID but occasionally surgical stabilisation of the spinal column may be necessary. It is concluded that spinal cord involvement in MIDs is more frequent than anticipated but may be missed if cerebral manifestations prevail. Spinal cord involvement in MIDs may strongly determine the mobility of these patients.

A clinical case study of long-term injury of the thoracic and lumbar spine

Overestimation of the efficacy of conservative treatment of spine injuries children often leads to unsatisfactory long-term results. The effective correction of post-traumatic spinal column deformities occurs in patients who undergo the operation in the early post-traumatic period. While choosing treatment strategies for children, higher reparative opportunities, which provide early fracture consolidation, including those in faulty positions, should be considered. This study presents a case of surgical treatment for uncomplicated injury of the thoracic and lumbar spine, with long-term compression fragmental fracture of the L1 vertebra body in a 12-year-old child. Due to the long-standing character of the injury right thoraco-frenotomy was conducted with partial L1 vertebral body and resection of the adjacent discs, deformity correction of the thoracic and lumbar spine with a transpedicular system, and ventral spondylodesis with an autograft. This extensive intervention was justified by the peculiarities in the vertebral body damage and the post-traumatic segmental kyphotic deformity that resulted from delayed medical treatment. An anterior approach was chosen to achieve immobilization at the site of the damage before correction using the transpedicular system. Surgical correction of long-term spinal injuries in children, with the use of a combined approach, is usually laborious and traumatic. The prevention of rigid post-traumatic spine deformities with the help of timely diagnostics and appropriate treatment, including surgery, should be a priority to prevent such cases.

Overutilization of bracing in the management of penetrating spinal cord injury from gunshot wounds.

OBJECTIVE Penetrating gunshot wounds (GSWs) to the spinal column are stable injuries and do not require spinal orthoses or bracing postinjury. Nonetheless, a high number of GSW-related spinal cord injury (SCI) patients are referred with a brace to national rehabilitation centers. Unnecessary bracing may encumber rehabilitation, create skin breakdown or pressure ulcers, and add excessive costs. The aim of this study was to confirm the stability of spinal column injuries from GSWs and quantify the overutilization rate of bracing based on long-term follow-up. METHODS This retrospective cohort study was performed at a nationally renowned rehabilitation center. In total, 487 GSW-related SCI patients were transferred for rehabilitation and identified over the last 14 years. Retrospective chart review and telephone interviews were conducted to identify patients who were braced at the initial treating institution and determine if late instability, deformity, or neurological deterioration resulted in secondary surgery or intervention. In addition, 396 unoperated patients were available for analysis after 91 patients were excluded for undergoing an initial destabilizing surgical dissection or laminectomy, thereby altering the natural history of the injury. All of these 396 patients who presented with a brace had bracing discontinued upon reaching the facility. RESULTS In total, 203 of 396 patients were transferred with a spinal brace, demonstrating an overutilization rate of 51%. No patients deteriorated neurologically or needed later surgery for spinal column deformity or instability attributable to the injury. All patients had stable injuries. The patterns of injury and severity of neurological injury did not vary between patients who were initially braced or unbraced. The average follow-up was 7.8 years (range 1-14 years) and the average age was 25 years (range 10-62 years). CONCLUSIONS The incidence of brace overutilization for penetrating GSW-related SCI was 51%. Long-term follow-up in this study confirmed that these injuries were stable and thus did not require bracing. No patients deteriorated neurologically, whether or not they were initially braced. The unnecessary use of spinal orthoses increases costs and patient morbidity. Reeducation and dissemination of this information is warranted.

Vertebral Histomorphometry in a Child with Glucocorticoid-Induced Osteoporosis

Vertebral fractures are an under-recognized problem in children with glucocorticoid-induced osteoporosis (GIO). They cause severe back pain and spinal column deformity with a decrease of quality of life. For evaluating the bone mass, bone mineral density measurements have been widely carried out using dual energy X-ray absorptiometry. However, bone histomorphometric analyses of GIO in children are scarce. Bone histomorphometric analyses of vertebral bodies have not been reported. Our aim is to report the first bone histomorphometric data for vertebrae from an autopsied child with GIO. A 15-year-old girl with systemic lupus erythematosus was started on a daily oral dose of 10 mg of prednisolone at 6 years of age. She presented with back pain from 12 years of age. Magnetic resonance imaging at 14 years of age showed a compression fracture of the first lumbar (L1) vertebral body. At 15 years of age, she died of heart failure owing to pulmonary hypertension. Collapsed (L1) and non-collapsed (seventh thoracic vertebrae; T7) vertebral bodies were autopsied for bone histomorphometry and compared. T7 showed severe osteoporosis (bone volume, 4.99%; trabecular thickness, 59 µm; trabecular separation, 1,134 µm). Compared with T7, L1 showed increased bone volume (33.9%) and trabecular thickness (77 µm), and decreased trabecular separation (156 µm) owing to the impact of the vertebral fracture. The bone formation and bone resorption parameters were comparable between the two vertebrae. These histological findings suggest that severe osteoporosis developed after long-term glucocorticoid administration, and that the remodeling activities were similar in the fractured and non-fractured vertebrae.

Identification of Apical Vertebra for Grading of Idiopathic Scoliosis using Image Processing

Scoliosis is a 3-D deformity of spinal column, characterized by both lateral curvature and vertebral rotation. The disease can be caused by congenital, developmental, or degenerative problems; but most cases of scoliosis actually have no known cause, and this is known as idiopathic scoliosis. Vertebral rotation has become increasingly prominent in the study of scoliosis and the most deformed vertebra is named as apical vertebra. Apical vertebral deformity demonstrates significance in both preoperative and postoperative assessment, providing better appreciation of the impact of bracing or surgical interventions. Precise measurement of apical vertebral rotation in terms of grading is most valuable for the determination of reference value in normal and pathological conditions for better understanding of scoliosis. Routine quantitative evaluation of vertebral rotation is difficult and error prone due to limitations of observer characteristic and specific imaging property. This paper proposes automatic identification of the apical vertebra and its parameter that depends on the objective criteria of measurement using active contour models. The proposed technique is more accurate and is a reliable measurement compared to manual and computer-assisted system.

Displasias vertebrales múltiples asociadas a Síndrome de Rokitansky: una causa poco frecuente de escoliosis congénita. A propósito de un caso

Vertebral dysplasia is a developmental defect, mainly of the vertebral bodies that cause severe spinal column and thoracic deformity that include congenital scoliosis and kyphoscoliosis. These vertebral anomalies can be classified as failure of formation, failure of segmentation, or a combination of both. The location and type of the vertebral defect determines the severity of the scoliosis. Is mandatory known that these abnormalities may be isolated or associated with concurrent neural, limb or visceral anomalies, which must be ruled out. Therefore additional imaging and genetical studies are necessary to provide evidence of these associated defects. Early diagnosis and rehabilitation treatment with exhaustive expectant watching are vital to prevent development of sever deformities and possible pulmonary complications. We report a representative case of multiple vertebral anomalies associated with Rokitansky Syndrome in a female who develops scoliosis during her puberty.

Relief of Superior Mesenteric Artery Syndrome with Correction of Multiplanar Spinal Deformity by Posterior Spinal Fusion

Superior mesenteric artery syndrome is obstruction of the third portion of the duodenum by compression between the abdominal aorta and superior mesenteric artery. Pediatric orthopedists are familiar with this entity, as the association between superior mesenteric artery syndrome and spinal fusion or body casting has been well established. However, patients with spinal deformities usually experience superior mesenteric artery syndrome after orthopedic intervention, with rates after corrective spinal surgery reported between 0.5% and 2.4%. Symptoms of superior mesenteric artery syndrome typically include nausea, bilious emesis, abdominal pain, early satiety, and anorexia. Initial treatment focuses on gastric decompression and maintaining euvolemia and electrolyte balance. The patient should receive enteral nutrition via nasojejunal tube or parenteral nutrition to allow for weight gain and subsequent resolution of the obstruction. The superior mesenteric artery takes off from the duodenum at an angle of 45 degrees to 60 degrees in normal individuals. The third portion of the duodenum is suspended between these vessels by the ligament of Treitz. Any variation in this relationship that decreases the arteriomesenteric angle may induce obstruction. Specifically, lumbar hyperextension or hyperlordosis can traction the mesentery and vessels. Only 2 cases of superior mesenteric artery syndrome in patients with sagittal plane spinal deformity have been described in the literature. In patients with concomitant superior mesenteric artery syndrome and spinal deformity, correction of the deformity may help alleviate the obstruction and result in faster recovery. The contribution of spinal column deformity to the arteriomesenteric angle should not be overlooked.

Surgical considerations of spinal ependymomas in the pediatric population

The objective of this manuscript is to discuss current management strategies regarding pediatric patients with intramedullary spinal cord ependymomas. Spinal ependymoma is the second most common spinal cord tumor in children. The clinical evaluation of these patients, operative techniques, postoperative management considerations, and long-term outcomes are discussed. The gold standard for the treatment of spinal ependymoma continues to be gross total resection. Patients with residual tumor postoperatively may benefit from adjuvant radiation therapy. Intraoperative monitoring is critical to minimize permanent postoperative neurologic deficit. Patients requiring multilevel laminectomy may benefit from concomitant laminoplasty or instrumented fusion to avoid progressive spinal column deformity.

Toxicity of Cadmium for Silver Catfish Rhamdia quelen (Heptapteridae) Embryos and Larvae at Different Alkalinities

The present study evaluated the effect of waterborne Cd in eggs and larvae of silver catfish, Rhamdia quelen, at two alkalinity levels (63 and 92 mg . L(-1) CaCO(3)): 0.5 (control), 4.5, 8, and 18 microg . L(-1) Cd. The fertilization rate was similar in all treatments, but the number of eggs with irregular surface was significantly higher in those exposed to 18 microg . L(-1) Cd and 63 mg . L(-1) CaCO(3). Three days after hatching survival of larvae exposed to 4.5 and 8 microg . L(-1) Cd and 63 mg . L(-1) CaCO(3) was significantly lower than that of control larvae, and 21 days after hatching survival decreased with the increase in waterborne Cd levels and total cadmium accumulation in the larvae. These significant differences and relationships were not observed in larvae maintained at 92 mg . L(-1) CaCO(3). Furthermore, in the lower alkalinity, a higher incidence of barbels and spinal column deformities was observed in the highest waterborne Cd concentration. At the end of the experimental period, 21 days after hatching, larval survival rate, length, weight, head height, membranous layer thickness, and biomass decreased with the increase in waterborne Cd levels in the lower alkalinity. However, these relationships were not observed in larvae maintained at 92 mg . L(-1) CaCO(3). The percentage specific growth rate was lower in larvae exposed to the highest waterborne Cd concentration at 63 mg . L(-1) CaCO(3). These results suggest that alkalinity of 92 mg . L(-1) CaCO(3) reduces waterborne Cd toxicity in silver catfish larvae.

Spinal deformity after multilevel osteoplastic laminotomy.

Multilevel laminectomy in children has a significant rate of postoperative spinal deformity. To decrease the incidence of this complication, the use of osteoplastic laminotomy is advocated to minimise the risk of spinal deformity by preserving the normal architecture of the spine. In this retrospective study, a 10-year series of a paediatric population undergoing multilevel osteoplastic laminotomy is reviewed to determine the incidence, especially in contrast to laminectomies, and to identify factors that affect the occurrence of spinal column deformity. Seventy patients (mean age 4.2 years) underwent multilevel osteoplastic laminotomy for congenital anomalies or removal of spinal tumours. All patients had a clinical and radiographic examination preoperatively, 12 months postoperatively and at follow-up. Mean follow-up was 5.3 years (range 3-12.6 years). Nineteen patients (27%) had a new or progressive spinal deformity. There was an increased incidence in patients who had surgery for spinal tumours (P<0.05), surgery of the cervical spine (<0.01), and who had more than five levels of the spine included (P<0.05). A review of the literature on children with multilevel laminectomy (n=330), the incidence of spinal deformity found a significantly higher (46%) compared to our study group. This study demonstrates that osteoplastic laminotomy was found to be very effective in decreasing the incidence of spinal deformities after spinal-canal surgery for spinal-cord tumours or congenital anomalies in children and adolescents. The choice of an anatomical reconstructive surgical technique such as osteoplastic laminotomy seems to be essential to minimise secondary problems due to the surgical technique itself. Nevertheless, growing patients should be followed up for several years after the initial operation for early detection and consequent management of any possible deformity of the spinal column.

Growth and Maturation of the Spine from Birth to Adolescence

Normal development of the spine, from birth, includes the progressive longitudinal and axial growth of an osseous spinal column that allows a neuroprotective mechanical axis for all motion throughout life. Growth of the spinal column may become eccentric during life and can result in spinal deformity. In the developing spinal column, there exist four general features that permit the successful growth of the human spine: 1. Osseous development is essential for the provision of a mechanical axis for the appendicular skeleton as well as an axis for muscular development. This axial skeleton has features that are unique to all mammalian bipeds. 2. Characteristic curves in the osseous spinal column need to develop once the child begins to sit upright and eventually walk. Lordotic cervical and lumbar segments begin to develop, and the development of kyphotic thoracic and sacral segments permits balance in the sagittal plane. 3. Continuous symmetric growth of the spinal column must occur while the child develops. Both longitudinal (vertical) and latitudinal (axial) growth must occur, and an eccentric growth in either direction can result in a spinal deformity. 4. Neural element protection remains highly important throughout development and in adult life. The developing osseous spinal column must also permit safe exit of all nerve roots. The spinal cord, as well as the osseous column around it, continues to lengthen. A variation in growth rates can occur, which may result in neurologic deficits and spinal column deformity (e.g., tethering of the cord and syringomyelia). In the early embryonic stage, the spinal cord extends to the end of the osseous column, and then, when the crown-rump length of the fetus is 120 mm, it ascends to the third or fourth lumbar vertebra1. A more gradual ascent then occurs, with the conus medullaris ending at the level of the first or second …

Endoscopic surgery on the thoracolumbar junction of the spine.

The thoracolumbar junction is the section of the truncal spine most often affected by injuries. Acute instability with structural damage to the anterior load-bearing spinal column and post-traumatic deformity represents the most frequent indications for surgery. In the past few years, endoscopic techniques for these indications have partially superseded the open procedures, which are associated with high access morbidity. The particular position of this section of the spine, which lies in the transition area between the thoracic and abdominal cavities, makes it necessary in most cases to partially detach the diaphragm endoscopically in order to expose the surgical site, and this also provides access to the retroperitoneal section of the thoracolumbar junction. A now standardised operating technique, instruments and implants specially developed for the endoscopic procedure, from angle stable plate and screw implants to endoscopically implantable vertebral body replacements, have gradually opened up the entire spectrum of anterior spine surgery to endoscopic techniques.