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Biomedical subjects

J E Lonstein

Publications and source records attributed to J E Lonstein.

99 records · Page 6Linked to original sources
PubMedDate not supplied

Spinal surgery in spinal muscular atrophy.

Fifteen patients with surgical treatment of spinal muscular atrophy were reviewed. The curve pattern was thoracic in 3, thoracolumbar in 11, and double thoracic and thoracolumbar in 1. Follow-up averaged 31 months. Eleven patients underwent posterior spinal fusion with Harrington instrumentation, with segmental wiring in four, and two had Luque instrumentation. The average age at time of surgery was 14.4 years. The average curve correction was 48%; that with the pelvic obliquity corrected, 63%. Surgery is best done when the curve is approximately 50-60 degrees, and Luque sublaminar wiring of Harrington or Luque rods with no external support appears to be the procedure of choice.

Adolescent↗
PubMedDate not supplied

Spinal deformities in patients with Friedreich ataxia: a review of 19 patients.

Nineteen patients with Friedreich ataxia and scoliosis were reviewed. The curve pattern was thoracic in six, thoracolumbar in six, double thoracic and lumbar in two, and double thoracic and thoracolumbar in five. Scoliosis was associated with hyperkyphosis in eight patients. Nonoperative treatment with braces was unsuccessful because of either increase of the curve despite the brace or difficulties with balance and coordination. Twelve patients underwent posterior spinal fusion with instrumentation. Average follow-up was 32 months. Postoperative immobilization was used in 10 patients and resulted in functional problems in only three. All fusions were solid at follow-up.

Adolescent↗
PubMedDate not supplied

Hip dislocation and subluxation in cerebral palsy.

Four hundred sixty-four patients with cerebral palsy were reviewed. They were placed in four function groups: independent ambulators (n = 76), dependent ambulators (n = 43), independent sitters (n = 41), and dependent sitters (n = 304). The percentage of subluxated or dislocated hips increased from 7% for independent ambulators to 60% for dependent sitters. In the dependent sitters, a level pelvis or different degrees of pelvic obliquity did not correlate with whether the hip was located, subluxated, or dislocated. The subluxated or dislocated hip did not correlate with the high side or the amount of pelvic obliquity. Muscle imbalance around the hip and not the pelvic obliquity is the cause of the hip subluxation or dislocation.

Adolescent↗
PubMedDate not supplied

Convex growth arrest for progressive congenital scoliosis due to hemivertebrae.

Thirteen patients with progressive congenital scoliosis due to hemivertebrae or hemivertebrae associated with other spinal anomalies were treated by convex anterior and posterior hemiarthrodesis and hemiepiphysiodesis. The average curve prior to operation was 46 degrees, average age was 3 years 6 months, and average followup was 6 years 6 months. One patient failed because of an inadequate length of anterior surgery which was successfully salvaged by further surgery. Twelve patients were successes: Seven had only cessation of the progressive curve, and five had progressive curve improvement greater than or equal to 5 degrees due to the arrested convex and persistent concave growth. This procedure is a valuable treatment modality for selected patients with congenital scoliosis.

Child↗
PubMedDate not supplied

Screening for spinal deformities in Minnesota schools.

Early detection of spine deformities by school screening has proven to be an effective mechanism for early diagnosis. The forward bending test is a simple rapid method of detection and has been used in the Minnesota State screening program. Screening in Minnesota began in 2 rural communities and spread to include the whole state. Over 570,000 children have been screened to the end of the 1975/1976 school year. The prevalence rate of 4.0% of rational prominences is the same as that found in other screening programs. The findings of a large number of small curves and the nearly equal sex ratio were unexpected, but reflect the recent literature. Even though a large number of normal spines are referred for physician evaluation by the screening, the benefits are great. The curves are detected when they are small, allowing progressive deformities to be detected early, promptly braced and deterioration prevented. The need for future surgical correction is thus decreased. The routine screening in Minnesota of school children for spine deformities has proved to be an effective method for the early detection of spine deformities. The screening test is rapid and easy--"a 30-second investment for a lifetime of dividends."

Braces↗
PubMedDate not supplied

Lumbosacral hemivertebrae. A review of twenty-four patients, with excision in eight.

Twenty-four cases of lumbosacral hemivertebrae are reviewed. The treatment groups consisted of observation, bracing, posterior spinal fusion with and without Harrington instrumentation, and two-stage hemivertebral excision. Clinical and radiographic spine decompensation was found to be an important parameter in following these patients. Results with observation and bracing were variable and unpredictable. The best surgical correction was obtained with lumbosacral hemivertebral excision.

Adolescent↗
PubMedDate not supplied

Complications of anterior spinal surgery in children.

The purpose of this study was to document the medical and surgical complications of anterior spine surgery in children and to identify risk factors for complications. A retrospective chart review was conducted of 599 anterior procedures (24 anterior only, 300 staged anterior/posterior, 175 combined anterior/posterior procedures) performed between 1967 and 1991. Major complications occurred in 7.5% of procedures and minor complications in 33%. Risk factors for major complications were age > 14 years, male gender, kyphotic curve type, curve sizes > 100 degrees, vital capacity < 40% of predicted, and use of thoracotomy. Risk factors for minor complications were age > 14 years, curves > 100 degrees, vital capacity < 40% of predicted, and use of a staged procedure. Multivariate analyses of risk factors identified age > 14 years and curves > 100 degrees as the most significant risk factors for major complications and age > 14 years for minor complications. We concluded that anterior spinal surgery can be performed in children with an acceptable level of risk and that referral for surgery before 14 years of age and before the curve size progresses will significantly reduce the risk of complications.

Adolescent↗
PubMedDate not supplied

Curve progression in Risser stage 0 or 1 patients after posterior spinal fusion for idiopathic scoliosis.

A retrospective review was performed to determine "crankshaft" prevalence in 86 immature patients who underwent posterior spinal fusion for idiopathic scoliosis. Tanner stage, chronologic age, bone age, and epiphyseal status were used as maturity indicators. Overall, 62 (72%) patients progressed < or = 10 degrees, 18 (21%) patients progressed 11-15 degrees, and six (7%) patients progressed > or = 16 degrees in the coronal plane. Tanner I patients with open triradiate cartilage had the highest rate of crankshaft occurrence; nine (75%) of 12 patients progressed >10 degrees (p < 0.05). Fifty-two percent of Tanner I, 26% of Tanner II, 11% of Tanner III, and no Tanner IV patients progressed >10 degrees (p < 0.05). Cobb angle increases of >10 degrees degrees occurred in 54% of patients with open triradiate cartilage (p < 0.05) and in 48% of patients with open capital femoral epiphyses (p < 0.05). Anterior and posterior spinal fusion should be considered in prepubertal (Tanner I) patients with open triradiate cartilage.

Adolescent↗