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Biomedical subjects

J E Lonstein

Publications and source records attributed to J E Lonstein.

At least 37 records · Page 2Linked to original sources
PubMed1997

The treatment of progressive kyphoscoliosis in camptomelic dysplasia.

STUDY DESIGN: This study evaluated the different forms of treatment of camptomelic dysplasia, a rare form of short-limbed dwarfism. OBJECTIVES: To determine the most efficacious form of management of spinal deformities in camptomelic dysplasia. SUMMARY OF BACKGROUND DATA: The literature on treatment of spinal deformities in camptomelic dysplasia is sparse. One report advocates aggressive surgical treatment to prevent curve progression and prevent already compromised respiratory function. METHODS: Eight patients with camptomelic dysplasia and progressive spinal deformity underwent a retrospective chart and radiographic review by an independent observer. Follow-up averaged 3 years and 9 months. RESULTS: Five of eight patients initially were treated with bracing and six of eight patients eventually required surgery. Average initial kyphosis was 114 degrees and scoliosis 61 degrees, compared with 99 degrees kyphosis and 52 degrees scoliosis at follow-up. Complications included pseudarthrosis (50%) and neurologic problems (33%). CONCLUSIONS: The authors advocate anterior/posterior uninstrumented fusion and halo cast immobilization postoperatively to prevent curve progression and avoid the potentially fatal sequelae associated with this disorder.

Braces↗
PubMed1997

Magnetic resonance imaging evaluation of the adolescent patient with idiopathic scoliosis before spinal instrumentation and fusion. A prospective, double-blinded study of 140 patients.

STUDY DESIGN: This was a prospective, double-blinded study of the magnetic resonance imaging findings in the neural axis of 140 neurologically normal typical adolescents with idiopathic scoliosis who were scheduled for scoliosis surgery. OBJECTIVE: To detect the prevalence of spinal cord and neural axis abnormalities in this select population. SUMMARY OF BACKGROUND DATA: No similar study exists, although a few related studies were published. METHODS: Full-length neural axis magnetic resonance imaging studies were reviewed independently by two radiologists who specialize in the spine. RESULTS: Only four patients had a definite abnormality-one a small thoracic syrinx and the other three with a Chiari malformation. None of these required neurosurgery. All 140 patients had their scoliosis surgery without necrologic compromise. CONCLUSION: Routine magnetic resonance imaging evaluation of neurologically normal, typical adolescents with idiopathic scoliosis is not warranted, based on this study.

Adolescent↗
PubMed1996

Comparison of the use of supine bending and traction radiographs in the selection of the fusion area in adolescent idiopathic scoliosis.

STUDY DESIGN: A study was done to evaluate the use of voluntary supine side bending radiographs and Risser table traction radiographs in adolescent patients undergoing posterior spinal fusion for idiopathic scoliosis. OBJECTIVES: To compare the usefulness of supine side bending and traction radiographs in assessing curve flexibility and determining fusion levels in patients undergoing posterior spinal fusion for adolescent idiopathic scoliosis. SUMMARY OF BACKGROUND DATA: Supine side bending radiographs have been used in the preoperative evaluation of idiopathic scoliosis to determine curve flexibility and fusion area. Traction films have been used to determine the flexibility of large curves and neuromuscular curves where active side bending is not possible. No study to date has compared the use of these films in patients with adolescent idiopathic scoliosis undergoing surgery. METHODS: Seventy-five patients with more than a 2-year follow-up period after surgery were included in this study. Preoperative radiographs included a standing posteroanterior and lateral film and both supine maximal voluntary side bending films and a traction film done on a Risser table. A preoperative review of these radiographs was done to determine curve flexibility and fusion levels. At follow-up evaluation, the patients were examined for any evidence of decompensation or "adding-on" of levels. RESULTS: For curves less than 60 degrees, side bending radiographs showed greater curve correction than traction radiographs, whereas the opposite was true for curves greater than 60 degrees. For King I and II curves, side bending radiographs were superior for determination of lumbar curve flexibility and for distinguishing these two types of curves. On traction radiographs, the stable vertebra was 1.4 vertebral levels higher than on the standing film. When the fusion level was moved proximally because of the traction radiograph, decompensation or "adding-on" commonly occurred. CONCLUSIONS: Supine bending radiographs are superior to traction radiographs for assessing curve flexibility except for curves more than 60 degrees. The selection of the distal extent of fusion based on the traction radiograph gave a large number of poor results. The selection of fusion levels in adolescent Idiopathic scoliosis is best determined by a combination of standing posteroanterior and lateral radiographs and the supine maximum voluntary bend films.

Adolescent↗
PubMed1996

Paraplegia resulting from vessel ligation.

STUDY DESIGN: This is a retrospective review of clinical records for evidence of paraplegia specifically resulting from segmental vessel ligation during anterior spinal surgery. OBJECTIVES: To determine the precise risk rate, and to potentially identify risk factors. SUMMARY OF BACKGROUND DATA: Although many authors have alluded to this risk, the exact risk rate and risk factors have never been identified. METHODS: All patients having an anterior approach involving T1-L3 were reviewed. The two reviewers were not involved in any of the surgeries. The 1197 cases were consecutive from 1967 to 1991. RESULTS: There were no paralyses. CONCLUSIONS: There would appear to be virtually no risk to segmental vessel ligation provided: 1) vessel ligation is unilateral, 2) done on the convexity of a scoliosis, 3) ligated at midvertebral body level, and 4) hypotensive anesthesia is avoided. Soft clamping with somatosensory-evoked potential monitoring does not appear justified.

Adult↗
PubMed1996

Wound infections in reconstructive spine surgery.

The development of a wound infection following reconstructive spine surgery depends on a multitude of factors. Although the diagnosis is often difficult, prompt recognition of the infection through appropriate testing is vital. Diagnosis should result in aggressive, surgical treatment combined with systemic antibiotics. Ultimately, though, the best treatment is prevention.

Adolescent↗
PubMed1995

The surgical and medical perioperative complications of anterior spinal fusion surgery in the thoracic and lumbar spine in adults. A review of 1223 procedures.

STUDY DESIGN: A retrospective review of 1223 thoracic and lumbar anterior spinal fusions was performed from 1969 through 1992. OBJECTIVES: To document the incidence and specific types of perspective complications related to anterior spinal fusions. SUMMARY OF BACKGROUND DATA: Despite the increased use of anterior spinal surgery, there has been little documentation of the specific types and frequencies of the complications associated with its use. METHODS: All Minnesota Spine Center patients age 18 years or older who had anterior spinal fusions between the levels of T1 and S1 from August 1969 to June 1992 were reviewed for the occurrence of perioperative complications. Surgical approach and technique and associated comorbidity was recorded. RESULTS: The risk of a complication was increased for patients over age 60 years, for women, and for patients with multiple preexisting health problems. Serious complications, such as death (0.3%), paraplegia (0.2%), and deep wound infection (0.6%) were rare. The complication rate for complications that were directly attributed to the anterior spinal surgery was 11.5%. CONCLUSIONS: Anterior spinal fusion surgery is a safe procedure and can be used with confidence when the nature of a patient's spinal disorder dictates its use. Complications are often approach specific.

Adolescent↗
PubMed1995

Excision of hemivertebrae and wedge resection in the treatment of congenital scoliosis.

The results of anterior and posterior excision or wedge resection of a hemivertebra and arthrodesis of the spine were reviewed retrospectively for thirty-seven patients. The degree of correction that was obtained and maintained, the balance and alignment of the trunk, changes in pelvic obliquity, and associated complications were evaluated. The average age at the time of the operation was twelve years (range, six months to forty-two years). The average duration of follow-up was six years (range, two to nineteen years). The resection was at the mid-thoracic level in six patients, at the thoracolumbar level in nine, at the mid-lumbar level in seven, and at the lumbosacral level in seventeen. (Two patients had an excision of a hemivertebra at two levels.) Instrumentation was used in twenty-eight patients. Postoperatively, all patients were managed with a body cast, with a unilateral or bilateral pantaloon extension, for four to six months. The instrumentation allowed early walking and the use of a unilateral rather than a bilateral pantaloon extension. The index curve (the curve containing the hemivertebra) averaged 54 degrees (range, 18 to 132 degrees) preoperatively, 33 degrees (range, 0 to 105 degrees) postoperatively, and 35 degrees (range, 0 to 110 degrees) at the most recent follow-up evaluation. A measurable improvement in balance was achieved and maintained in nineteen patients. Pelvic obliquity did not change appreciably, as it was related primarily to limb-length inequality in this series. Complications included a temporary nerve-root lesion in seven patients, a permanent neurological deficit involving the first sacral nerve root in one patient, a pseudarthrosis in three patients, and a wound infection in three patients. Six patients had extension of the arthrodesis to include additional vertebrae.

Adolescent↗
PubMed1995

Segmental spinal dysgenesis. A disorder different from spinal agenesis.

We reviewed the clinical and roentgenographic findings, treatment, and results for seventeen patients (six male and eleven female) who had segmental spinal dysgenesis, a disorder frequently confused with, but distinct from, lumbar and lumbosacral agenesis. The average age at the time of presentation to the Minnesota Spine Center or the Gillette Children's Hospital was two and a half years (range, newborn to twenty-one years), and the average duration of follow-up was eight years (range, five months to twenty-two years). At the time of the diagnosis, eight patients had neurological deficits: seven had a neurogenic bladder and four had weakness of the lower extremities. An average of 2.6 procedures (range, one to five procedures) was needed to obtain a solid fusion. Decompression of the stenotic canal was performed in ten patients, and it was followed by an improvement in neurological function in two of them. A solid fusion of the spine, arrest of the progressive kyphosis, and stabilization of neurological function were obtained in all patients. We recommend early anterior and posterior arthrodesis in patients who have segmental spinal dysgenesis, as the progressive kyphosis that inevitably develops often results in neurological deficits.

Adolescent↗
PubMed1994

Deep venous thrombosis and pulmonary embolism after major reconstructive operations on the spine. A prospective analysis of three hundred and seventeen patients.

We performed a prospective study of 317 patients in order to determine the prevalence of deep venous thrombosis after reconstructive operations on the spine; 126 of the patients were examined with duplex ultrasound assessments of the lower extremities to ensure that no asymptomatic thrombi were being missed. Thigh-high stockings and sequential pneumatic compression of the lower extremities were used, in all patients, for prophylaxis against venous thrombosis. No antiplatelet agents or anticoagulant medications were administered. There was no evidence of thrombosis on any of the duplex ultrasound studies. Subsequently, venous thrombosis developed and was treated successfully in one of the 126 tested patients and in one of the 191 untested patients, and a fatal pulmonary embolus developed in one of the untested patients. The over-all clinical prevalence of thrombotic complications was 0.9 per cent (three complications in 317 patients). All three of the patients who had clinical evidence of thrombosis had had an anterior lumbar procedure because of a degenerative disorder or trauma; however, we could not prove that this approach or these diagnoses were significant risk factors for thrombosis (p < 0.05). While it is possible that some thrombi may have escaped both clinical and ultrasonic detection, such thrombi apparently were not enough of a danger to warrant the use of intensive prophylactic procedures that are associated with more risk. On the basis of this prospective study, therefore, we think that routine screening for the detection of asymptomatic thrombosis in patients who have had a procedure on the spine is unwarranted.

Adolescent↗
PubMed1994

The Milwaukee brace for the treatment of adolescent idiopathic scoliosis. A review of one thousand and twenty patients.

We reviewed the medical records and roentgenograms of 1020 patients who had been managed for adolescent idiopathic scoliosis, between January 1954 and December 1979, with a Milwaukee brace; we wished to determine whether use of the brace had effectively altered the natural history of the disease. The findings were considered with respect to a previous study of 727 children who had had comparable curves and had not initially been managed with the brace but had been followed for progression of the curve, during the same time-span as that in the current study. Of those 727 patients, 558 (77 percent) had no progression of the curve. The average age of the 1020 patients at the time that treatment with the brace was begun was thirteen and one-half years (range, ten to seventeen years). None of the patients had received any other treatment, and all had been managed only by the physicians participating in this study. In both the current and the earlier series, the outcome was considered a failure if the curve had increased 5 degrees or more; in the patients in the current study, who were managed with the brace, the outcome was also considered a failure if operative intervention had been needed. Of the 1020 patients in the current series, 229 (22 percent) had operative intervention; this rate was higher in the patients who had a curve of more than 30 degrees at the time of bracing and in those who had a Risser sign of 0 or 1. The 791 remaining patients, who were managed with the brace only, had a mild improvement of 1 to 4 degrees at the time that use of the brace was discontinued (the difference being within the margin of error of measurement). With respect to curves of between 20 and 39 degrees, the rate of failure was lower in the current series of patients who had been managed with the brace than in the earlier series of patients who had not been thus managed but had been followed for progression. Progression of the curve was found to be related to the pattern and magnitude of the curve; the age of the patient at the time of presentation; the Risser sign; and, in girls, the menarchal status. We recommend that immature adolescents who have a curve of more than 25 degrees and a Risser sign of 0 be managed with a brace immediately, rather than after progression has been documented.

Adolescent↗
PubMed1994

Scoliosis secondary to rib resection.

The case histories of 11 patients (five adults and six children) who presented with scoliosis after multiple rib resection for several disorders were reviewed. All 11 cases developed scoliosis with the convexity directed toward the side of the rib resection. The natural history of the scoliosis was progressive, and the younger the age at the time of rib resection, the more severe the progression. The rate of progression was greatest during the first 10 years after rib resection. The five patients who presented as adults were treated in several ways, only one requiring spine fusion. However, five of the six children required spine fusion to prevent progression of scoliosis.

Adolescent↗
PubMed1994

The Galveston technique using Luque or Cotrel-Dubousset rods.

The Galveston technique for pelvic fixation in long fusions to the sacrum in neuromuscular and adult scoliosis is an effective technique to help obtain a solid fusion. With careful technique and accurate rod bending, rod insertion, rod contouring, and wire tightening, excellent fixation is obtained that maximizes the fusion rate.

Adult↗
PubMed1993

Analysis of the upper thoracic curve in surgically treated idiopathic scoliosis. A new concept of the double thoracic curve pattern.

The authors reviewed 246 idiopathic scoliosis patients with the upper thoracic curve of more than 20 degrees. Group I (138 patients) had positive T1 tilt and a spinal fusion which was extended over both the upper and lower thoracic curve with the diagnosis of double thoracic curve. Group II (43 patients) had positive T1 tilt, but the fusion was limited to the lower thoracic curve. Group III (65 patients) had negative or neutral T1 tilt and the fusion was limited to the lower thoracic curve. The average age at operation was 15.9 years (range, 11.2-35 years) and the average length of follow-up was 4.8 years (range, 2-29.5 years). Positive T1 tilt did not correlate well with left shoulder elevation contrary to previous reports. The upper thoracic curve was more rigid than the lower curve in all groups and the lumbar curve was significantly more flexible than the upper and lower thoracic curves in all groups (P < 0.05). No significant difference in the flexibility of the upper thoracic curve was found between the groups regardless of the direction of T1 tilt. When only the lower curve was fused (groups II and III), progression of the upper thoracic curve was less than 5 degrees, and spontaneous correction of the unfused upper curve occurred in the majority of the cases following the supine bending study. Correction and fusion on the lower curve (groups II and III) aggravated shoulder imbalance of all patients with left shoulder elevation. Based on the findings of this study, the authors proposed that the diagnosis of idiopathic double thoracic patterns should be limited to those patterns which require fusion of both the upper and lower curves. This pattern of idiopathic scoliosis includes double thoracic curves with left shoulder elevation and/or a rigid upper thoracic curve.

Adolescent↗
PubMed1992

Osteogenesis imperfecta. Radiographic classification, natural history, and treatment of spinal deformities.

The natural history of the radiographic changes associated with osteogenesis imperfecta was recorded for sixty-four patients. Detailed clinical data regarding spinal deformities were available for forty-three patients. The patients could be placed in six well defined groups on the basis of a cluster of radiographic changes. The radiographic criteria used to classify patients who had osteogenesis imperfecta included the shape, dimensions, and appearance of the long bones; the presence of a trefoil pelvis and protrusio acetabuli; and the shape of the vertebrae. Patients can be classified more accurately if the dynamic nature of the radiographic changes is appreciated. Patients who had Type-A disease, a mild form of osteogenesis imperfecta, maintained the contours of the vertebrae. Most had straight long bones except for five patients who had mild bowing. Patients who had Type-B disease had bowed long bones with wide cortices. The pelvis had a normal contour. The vertebral bodies were biconcave, and kyphosis and scoliosis developed. Patients who had Type-C disease had thin, bowed long bones, and protrusio acetabuli developed around the age of ten years. Patients who had Type-D disease had the same findings as those who had Type-C disease, with the additional finding of cystic changes around the knee by the age of five years. The physes closed early, and the cysts disappeared around the age of fifteen. Patients who had Type-C or D disease had development of severe spinal deformities. Patients who had Type-E disease were totally dependent functionally, and spinal deformities developed at a very early age. The long bones appeared to have no cortex. Patients who had Type-F disease had complete disruption of the ribs, which was incompatible with survival. The natural history of scoliosis in the patients who had Type-B, C, D, or E disease was one of progression of the curve. Bracing used in the treatment of scoliosis in one patient who had Type-E disease and five patients who had Type-C disease was unsuccessful. Arthrodesis of the spine prevented progression of the spinal deformities in patients who had Type-A disease, but the results of the operation were variable in the remaining types of the disease.

Adolescent↗