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Biomedical subjects

J V Banta

Publications and source records attributed to J V Banta.

At least 37 records · Page 2Linked to original sources
PubMed1992

The myelodysplastic hip and scoliosis.

To investigate the relationship between unilateral hip dislocation or subluxation and scoliosis, the records were examined of 31 patients aged 10 to 26 years with myelomeningocele and an initial neurosegmental level of L3 or L4. 11 patients had deteriorated neurologically over time; the remainder had stable neurological examinations, with an average follow-up of 14.3 years. Scoliosis occurred in three of the nine patients with unilateral hip instability, compared with five of the 11 remaining patients. Only two patients had the expected pattern of unilateral hip instability on the high side of an oblique pelvis, with scoliosis convex to the opposite (low) side. Several unexpected patterns were observed. The functional neurosegmental level is not stable in many patients with myelodysplasia. In neurologically stable patients, unilateral hip instability and scoliosis are comorbid factors and no causal relationship was identified.

Adolescent↗
PubMed1992

[Spinal disorders in cerebral palsy--surgical procedure].

The incidence of scoliosis in cerebral palsy is related to the severity of the neurological involvement, being most prevalent in patients with spastic quadriplegia. Neuromuscular spinal deformity, when present, may progress after cessation of skeletal growth, and the success of orthotic treatment for scoliosis is unpredictable. Hip pathology is directly related to pelvic obliquity but has no causal relationship to the development of scoliosis. Adequate preoperative nutritional assessment is vital to reduce perioperative complications, and segmental spinal fixation is the instrumentation of choice. Anterior arthrodesis is indicated for rigid deformities and for those thoracolumbar and lumbar curves extending into the pelvis with pelvic obliquity and spinal decompensation.

Adolescent↗
PubMed1991

Parawalker: energy cost of walking.

Relative oxygen cost (ml/kg/m) was compared in five paraplegic subjects (4 children, 1 adult) while wearing a reciprocating gait orthosis (RGO) and Parawalker. An Oxylog was used to record oxygen consumption while the subjects ambulated during steady state. Although all of the subjects trained and used the orthoses for varying amounts of time, the trend from these data shows that the Parawalker enables a more energy efficient gait. On the average the oxygen cost while using the Parawalker was 27% less compared to the RGO. The reductions in oxygen cost ranged from 12 to 42%. Following this trend of greater efficiency, the subjects ambulated 33% faster (on the average) with the Parawalker than with the RGO. These preliminary results indicate that the Parawalker appears to be a more efficient orthosis for level ambulation in the paraplegic population.

Adult↗
PubMed1991

Peri-operative jejunostomy-tube feeding in reconstructive spinal surgery.

Eight malnourished children with neuromuscular spinal deformity were treated with jejunostomy tubes for supplemental feeding to attain appropriate weight before reconstructive surgery. All patients had significant gastro-esophageal reflux and had failed to gain weight during an eight-month oral supplementation program. There were no complications associated with the placement or use of the jejunostomy feeding tubes and all patients gained weight in a safe and predictable fashion, had successful spinal fusion and have maintained satisfactory weight at follow-up. Jejunostomy feeding is a safe and effective method of correcting malnutrition in patients with spinal deformity which precludes gastrostomy and Nissen fundoplication.

Adolescent↗
PubMed1990

Combined anterior and posterior fusion for spinal deformity in myelomeningocele.

Since 1973, 50 of 54 children have been treated by the author with a combined anterior and posterior fusion. Twenty males and 34 females, ranging in age from 1 to 16 years, have been followed for a mean period of 5.5 years. Sixteen patients with a kyphosis averaging 113 degrees (range, 77 to 170 degrees) had correction of deformity to a mean of 35 degrees. Thirty-seven patients with a scoliosis averaging 73 degrees (range, 20 to 135 degrees) had correction to an average of 34 degrees (range, 0 to 75 degrees). There were 4 cases of deep wound infection successfully treated with drainage and antibiotics and only one case required implant removal after fusion/maturation. A pseudarthrosis was noted by radiograph in 6 patients, 3 of whom had isolated asymptomatic lumbosacral pseudarthroses. Three patients had pseudarthrosis at the thoracolumbar junction. These required repair and were successfully treated by supplemental posterior fusion resulting in an overall pseudarthrosis rate of 5.7%. Anterior fusion of the dysraphic spine allows greater correction of both spinal deformity and pelvic obliquity in addition to contributing significant strength to the fusion mass. Segmental spinal instrumentation with sublaminar and pedicular wiring to custom-contoured Luque rods provides excellent correction and immediate postoperative stability.

Child↗
PubMed1989

Spinal fusion augmented by luque-rod segmental instrumentation for neuromuscular scoliosis.

Seventy-four patients who had deformity of the spine secondary to a neuromuscular disorder were treated using posterior fusion with Luque-rod segmental instrumentation. The mean curve was 73 degrees preoperatively and 38 degrees postoperatively. The mean loss of correction was 4 degrees at an average duration of follow-up of forty-two months (range, 2.0 to 7.3 years). Complications included one death, three deep wound infections, two pressure sores, six sets of broken rods, and one instance of distal rotation and migration of the rod. There were no major perioperative neurological complications. Failure of instrumentation occurred more frequently with 3/16-inch (4.8-millimeter) diameter than with 1/4-inch (6.4-millimeter) diameter stainless-steel rods. There was a tendency for cephalad progression of deformity when the fusion ended cephalad at or below the fourth thoracic vertebra. We concluded that Luque-rod segmental instrumentation with posterior spinal fusion is an effective treatment for patients who have neuromuscular scoliosis.

Adolescent↗
PubMed1987

The evolution of surgical treatment of spinal deformity in myelomeningocele.

Although modern anterior and posterior fusion techniques can provide excellent correction of dysraphic spinal deformities, the surgery can be formidable. Newer surgical techniques utilizing segmental spinal fixation of implants has afforded both a greater degree of three-dimensional correction of spinal deformity and more rigid control of the fusion mass. However, due to the inherent loss of posterior elements and the associated high level of paralysis, the use of bivalved total contact spinal orthoses are essential to achieving a high fusion rate with a minimum number of complications.

Child↗
PubMed1986

Adolescent idiopathic scoliosis treated by Harrington-rod distraction and fusion.

One hundred and thirty-three patients who had adolescent idiopathic scoliosis were treated by insertion of a single Harrington distraction rod and spinal fusion. Postoperative immobilization consisted of six months in a below-the-shoulder cast. The mean preoperative curve was 50 degrees, with a range of 30 to 110 degrees. The mean final curve was 35 degrees, with a range of 19 to 63 degrees. There were no neurological injuries and no deep wound infections. Twelve patients required further surgery for complications, all of which were treated successfully. The duration of follow-up ranged from twenty-four to seventy-two months. At final follow-up, all patients had resumed their normal preoperative activities without limitations.

Adolescent↗
PubMed1986

Intraspinal rhizotomy and distal cordectomy in patients with myelomeningocele.

Intraspinal rhizotomy alone or in combination with excision of the scarred conus medullaris distal to the level of the cord anomaly was used in thirteen patients with myelomeningocele at the thoracolumbar level whose care was complicated by recurrent deformity of the lower extremities that was caused by persistent spasticity. When examined at an average follow-up of 5.3 years, all patients were free of spasticity, had manageable lower extremities, and were able to sit in a wheelchair with ease. Twelve patients had no change in the status of the urinary tract, but one patient noted an adverse change in urinary status with increased wetness between intermittent catheterizations. Intraspinal rhizotomy alone or in combination with distal cordectomy should be used only in patients with congenital paraplegia in whom reflex motor activity has caused recurrent deformity of the lower extremities that cannot be controlled by the use of braces or operations on the lower extremities, or both.

Adolescent↗
PubMed1985

Talectomy for equinovarus deformity in myelodysplasia.

Nine patients with myelomeningocele (seventeen involved feet) had talectomy for the correction of equinovarus deformity. The age at surgery ranged from one year and eight months to seven years and four months old. The length of follow-up averaged seven years and four months and ranged from twenty-two months to twelve years. Fifteen feet had a good and two had a poor correction of the deformity of the hind part of the foot, the result being directly related to the intraoperative correction of the equinus deformity. The correction of the fore part of the foot was rated as good in eight, fair in one, and poor in eight feet. Residual deformity of the fore part of the foot compromised the functional result in six feet that had an acceptable correction of the deformity of the hind part.

Child↗
PubMed1983

Improvement in pulmonary function in patients having combined anterior and posterior spine fusion for myelomeningocele scoliosis.

Thirteen patients with myelomeningocele scoliosis whose surgery necessitated anterior exposure of the thoracic spine were tested for changes in pulmonary function following spinal stabilization. The majority of patients exhibited a T12 level paralysis and a mean scoliosis of 72 degrees. Average correction of scoliosis for the series was 63%, and two cases with one level pseudarthrosis had no loss of correction. Ten of 13 patients were tested for pulmonary function one month prior to surgery and an average of ten months postoperatively. Eight of the ten patients demonstrated increase in peak flow postoperatively. Five demonstrated increase in maximum voluntary ventilation, and six cases showed increased functional residual capacity. Forced vital capacity increased in two, decreased in five, and showed no change in three patients. Improvement in peak flow, maximum voluntary ventilation, and functional residual capacity was noted in all five cases with scoliotic deformity in excess of 60 degrees (mean 93 degrees). It is postulated that, following spinal stabilization, these patients are able to improve their thoracic mechanics, enhancing greater expiratory flow with greater endurance.

Adolescent↗
PubMed1981

Anterior tibial transfer to the os calcis with Achilles tenodesis for calcaneal deformity in myelomeningocele.

Seven children aged 3.0 to 5.8 years underwent bilateral simultaneous transfer of the anterior tibial muscle to the os calcis combined with Achilles tenodesis. All patients underwent pre- and postoperative gait analysis. Results indicated decreased knee flexion in stance and decreased ankle dorsiflexion in stance resulting in a more upright posture in all patients. Electromyography revealed prolongation of firing time in both stance and swing phase of the gait cycle. Polypropylene ankle-foot orthoses, used to protect the transfers in the postoperative period, improved step length, single limb support, and walking velocity in all patients. Three patients underwent force plate analysis to calculate work output. The reduction in work from 1.578 to 0.628 joules/kg/m suggested a favorable reduction in the work required to ambulate following surgery. No equinus deformity developed as a consequence of the Achilles tenodesis. These preliminary findings suggest the combined procedure restored a more optimal balance to the foot and ankle. Postoperative orthotic support was beneficial for protection of the corrected alignment as well as long-term function.

Achilles Tendon↗
PubMed1979

Epidemiology of waterskiing injuries.

Coast Guard statistics indicate a national boating fatality rate of 9.6 deaths per 100,000 crafts. In 1977 in California, five fatalities and 70 serious injuries were directly attributable to waterskiing. The four cases reported here include three patients with propeller injuries, including one nearly fatal amputation. In each case basic measures for boating safety were overlooked.

Adult↗
PubMed1975

Arthrocentesis of the knee in acute hemophilic arthropathy.

In 27 children and young adults with hemophilia presenting acutely painful distended intra-articular hemorrhages of the knee, aspiration was carried out and the patients were followed for a minimum of 24 months. Seventeen patients with classical hemophilia were found to have less than 1 percent of normal plasmal level of antihemophilic factor (AHF). Of the remainder, five were Factor IX, plasma thromboplastin component (PTG), deficient, whereas two patients had Von Willebrand's disease. Aspiration was routinely done in an outpatient clinic, followed by immediate discharge with return to regular activity levels within 48 hours. There were no infections nor rehemorrhages attributable to aspiration technique.

Adolescent↗