Biomedical subjects

O Boachie-Adjei

Publications and source records attributed to O Boachie-Adjei.

At least 19 recordsLinked to original sources

PubMed2001

The efficacy of antifibrinolytics in the reduction of blood loss during complex adult reconstructive spine surgery.

STUDY DESIGN: Controlled study to assess the efficacy of aprotinin and Amicar in reducing blood loss during complex spinal fusions. OBJECTIVES: To compare blood loss and the clotting profile with a thromboelastogram in patients with spinal deformities undergoing sequential anterior and posterior spinal fusions treated intraoperatively with either aprotinin or Amicar. SUMMARY OF BACKGROUND DATA: Spinal fusion for correction of adult spinal deformities is associated with large blood losses despite the implementation of multiple factors to reduce this blood loss. The antifibrinolytics aprotinin and Amicar have both been shown to reduce blood loss in other surgical procedures with the potential for large blood loss. Hence, we compared their efficacy for reducing blood loss in complex spinal fusions. METHODS: Sixty patients for elective sequential anteroposterior thoracolumbosacral fusions were randomly assigned to three groups: control, aprotinin, and Amicar. Patients were assessed for blood loss, transfusion requirements, postoperative complications, and coagulation profile using a thromboelastogram. RESULTS: The study demonstrated a significant reduction in total blood loss (aprotinin 3628 mL, Amicar 4056 mL, control 5181 mL) and transfusion requirements using the half-dose aprotinin regimen compared with Amicar or control. Aprotinin also preserved the thromboelastogram mean clot formation time, clot strength, and clotting index compared with Amicar or control. CONCLUSIONS: For complex spinal operations with large blood losses, the half-dose aprotinin regimen will reduce blood loss and the need for blood components and may have a role in reducing postoperative lung injury.

Aminocaproic Acid↗

PubMed2001

Multiple vertebral osteotomies in the treatment of rigid adult spine deformities.

STUDY DESIGN: Retrospective review of the clinical and radiographic results in adult revision spine deformity surgery using the techniques of osteotomies to effect spine balance and curve correction. OBJECTIVES: To assess the efficacy of multiple vertebral osteotomies in correction of rigid spine deformities in adult patients undergoing revision surgery. METHOD: The records and radiographs of 27 adult patients with idiopathic scoliosis who underwent revision surgery requiring anterior release (discectomy and/or osteotomy) and posterior osteotomy to correct rigid spinal deformities were retrospectively reviewed. RESULTS: All 27 patients were available for follow-up evaluation. Fifteen patients had anterior discectomies followed by posterior osteotomies, whereas 12 had anterior and posterior osteotomies in staged or sequential (same day) fashion. Diagnosis was idiopathic scoliosis for the index operation. At revision, the primary deformity was flatback deformity in 10 patients and pseudarthrosis with progressive deformity in 17 patients. Eleven patients had predominant sagittal decompensation, 11 patients had multiplanar decompensation, and five patients were balanced. The average number of osteotomies performed anteriorly was 4.3 levels (range, 1-8) and the average number of osteotomies posteriorly was 4.6 levels (range, 1-10). There were a total of nine complications in eight patients including three pseudarthroses (11%), five hardware failures (19%), and one transient neurologic deficit (4%). There were no deep wound infections, deep vein thromboses, pulmonary emboli, or deaths. The average scoliosis correction was 40% (range, 5-81%), whereas the average sagittal balance was corrected 6.5 cm (range, -5-29.5 cm), on average, and coronal balance was corrected 2.5 cm (range, 1-6 cm), on average. CONCLUSION: This study demonstrates multiple vertebral osteotomies (anterior and/or posterior) in the management of rigid adult spine deformities and deformity correction with an acceptable complication rate. Use of vertebral osteotomies for patients undergoing revision spine surgery is a safe and reasonable approach to obtain an arthrodesis.

Adult↗

PubMed2001

Evidence of lung injury during reconstructive surgery for adult spinal deformities with pulmonary artery pressure monitoring.

STUDY DESIGN: Observational analyses of 55 adult patients who underwent elective sequential anterior-posterior thoracolumbosacral surgical corrections for spinal deformities were used to evaluate the efficacy of pulmonary artery catheter monitoring. OBJECTIVE: To demonstrate that during complex reconstructive surgery for spinal deformities, pulmonary artery catheter monitoring identifies a subset of patients with pulmonary injury and is essential in their management. SUMMARY OF BACKGROUND DATA: Patients who undergo sequential anterior-posterior thoracolumbosacral surgical corrections for spinal deformities experience significant perioperative morbidity. Although the value of pulmonary artery catheter monitoring is controversial, its use in these procedures may help identify potential physiologic complications and improve surgical outcome. METHODS: All patients were monitored with a pulmonary artery catheter during surgery until at least postoperative day 1. Outcome measurements included blood loss, vertebral levels fused, operative time, postoperative respiratory complications, and days in intensive care. RESULTS: Eight (8/55; 14.5%) patients according to pulmonary artery catheter monitoring demonstrated elevated pulmonary vascular resistance and noncardiac pulmonary edema. These patients had longer operative procedures with greater blood loss and had more postoperative respiratory complications. They were treated appropriately in intensive care and discharged without further complications. CONCLUSION: Pulmonary artery catheter monitoring of patients who undergo complex spinal fusion facilitates the identification of patients with pulmonary injury and is essential in the management of these patients in the postoperative period. It may, also, be a marker for embolic injury to the lung.

Adult↗

PubMed2001

Surgical treatment of adolescent idiopathic scoliosis: a comparative study of two segmental instrumentation systems.

This study compares two different surgical techniques and instrumentation types in the treatment of adolescent idiopathic scoliosis. The charts and radiographs of 116 patients with adolescent idiopathic scoliosis treated by posterior spine fusion with Isola or Cotrel-Dubousset instrumentation were reviewed. Patients were separated into two equivalent groups matched for age, sex, curve type, and curve magnitude. All patients had a minimum of 2 years follow-up. The instrumentation in group 1 consisted of hooks, wires, and pedicle screws. That used in group 2 was limited to hooks and rods. The Mann-Whitney, Wilcoxin, and the paired Student t tests for matched pairs were used for statistical analysis. Patients in group 1 had increased curve correction (66% vs. 52%), apical vertebral translation (63% vs. 30%), and correction of the end vertebral tilt angle (11 degrees vs. 3 degrees) (p < 0.001). The percentage of coronal curve correction in curves larger than 65 degrees also was greater in group 1 (59% vs. 40%). Physiologic sagittal alignment was obtained in 80% of the patients in group 1 and 25% in group 2. No major complication or pseudoarthrosis occurred in either group. This study supports improved correction of curve magnitude, apical translation, and end vertebral tilt angle with the use of multiple anchor types compared with the correction achieved with standard hook-and-rod constructs.

Adolescent↗

PubMed2001

Medical complications in scoliosis surgery.

Several medical complications can occur after scoliosis surgery in children and adolescents. They include the syndrome of inappropriate antidiuretic hormone; pancreatitis; cholelithiasis; superior mesenteric artery syndrome; ileus; pnemothorax; hemothorax; chylothorax; and fat embolism. This review focuses on the pathophysiology, diagnosis, and treatment of the various conditions that occur after correction of spinal deformity. Attention is given to recent literature specifically related to scoliosis surgery. Surgical complications like urinary tract infection, wound infection, and hardware failure will not be addressed.

Adolescent↗

PubMed2001

Clinical value of routine preoperative magnetic resonance imaging in adolescent idiopathic scoliosis. A prospective study of three hundred and twenty-seven patients.

BACKGROUND: The prevalence of intraspinal pathology associated with scoliosis has been reported to be as high as 26% in some series, and, on the basis of this finding, preoperative magnetic resonance imaging is used in the screening of patients with adolescent idiopathic scoliosis. However, this practice continues to be highly controversial. In order to better resolve this issue, we performed what we believe to be the largest prospective study to evaluate the need for preoperative magnetic resonance imaging in patients with adolescent idiopathic scoliosis requiring arthrodesis of the spine. METHODS: A total of 327 consecutive patients with adolescent idiopathic scoliosis were evaluated between December 1991 and March 1999. All patients in the study presented with an adolescent idiopathic scoliosis curve pattern and had a complete physical and neurologic examination. Magnetic resonance imaging of the brain and the spinal cord were performed as part of their preoperative work-up. RESULTS: Seven patients had an abnormality noted on magnetic resonance imaging. These abnormalities included a spinal cord syrinx in two patients (0.6%) and an Arnold-Chiari type-I malformation in four (1.2%). One patient had an abnormal fatty infiltration of the tenth thoracic vertebral body. No patient required neurosurgical intervention or additional work-up. All patients who underwent spinal arthrodesis with segmental instrumentation tolerated the surgery without any immediate or delayed neurologic sequelae. CONCLUSIONS: The fact that magnetic resonance imaging did not detect any important pathology in the large number of patients in this study strongly suggests that magnetic resonance imaging is not indicated prior to arthrodesis of the spine in patients with an adolescent idiopathic scoliosis curve pattern and a normal physical and neurologic examination.

Adolescent↗

PubMed2000

Safety of sublaminar wires with Isola instrumentation for the treatment of idiopathic scoliosis.

STUDY DESIGN: To investigate the incidence of acute neurologic complications of use of sublaminar wires with third-generation spine instrumentation for the treatment of idiopathic scoliosis. OBJECTIVES: To assess the safety of sublaminar wires in the surgical treatment of idiopathic scoliosis. SUMMARY OF BACKGROUND DATA: The use of sublaminar wires in spine deformity for neuromuscular scoliosis and the Luque system has been reported. Use of sublaminar wires is an integral part of the technique in the surgical treatment of spine deformity with Isola instrumentation (AcroMed, Cleveland, OH). To date, the safety of this technique has not been documented. METHODS: The average age of the patients was 37 years (range, 11-74 years). Preoperative diagnosis was adolescent idiopathic scoliosis in 75 patients and adult idiopathic scoliosis in 66. One hundred nine were primary surgeries, and 32 were revision. Detailed evaluation of the curve type, curve magnitude, number of vertebrae instrumented, level of vertebrae wired, postoperative neurologic deficit, and the findings of intraoperative spinal cord monitoring was performed. Wires were always passed just before corrective maneuvers were performed. RESULTS: A total of 1366 wires were placed, 65% (n = 888) in the thoracic region, 22% (n = 300) in the thoracolumbar, and 13% (n = 178) in the lumbar. No permanent change in intraoperative spinal cord monitoring was detected. Stagnara wake-up test was performed in all patients. No patient with adolescent idiopathic scoliosis had neurologic complication. Two adults underwent revision surgery and had transient dysesthesia in the leg, which completely resolved with observation. CONCLUSION: Despite the increasing complexity of spinal instrumentation systems, sublaminar wire placement is a safe and useful adjunct in the surgical treatment of neurologically intact patients with idiopathic scoliosis.

Adolescent↗

PubMed2000

Safety and efficacy of pedicle screw placement for adult spinal deformity with a pedicle-probing conventional anatomic technique.

A prospective study of 50 adults treated with fusion, realignment, and segmental spinal instrumentation for spinal deformity was conducted to assess the safety, accuracy, and efficacy of the free-hand pedicle screw placement technique. Postoperative computed tomographic scans were performed to evaluate the placement of 282 screws and were correlated with patients' clinical outcomes. Five screws were placed at T12, 26 at L1, 39 at L2, 48 at L3, 73 at L4, 35 at L5, and 50 at S1. Nine screws (3%) were misplaced and included three screws (1.06%) that violated the medial wall with no clinical sequelae or revision surgery needed. There were no neurologic deficits related to screw placement. The free-hand technique is a safe and cost-effective method for pedicular screw placement during surgery for adult spine deformities.

Adult↗

PubMed1999

Idiopathic scoliosis. The clinical value of radiologists' interpretation of pre- and postoperative radiographs with interobserver and interdisciplinary variability.

STUDY DESIGN: A retrospective analysis of radiographic reports of 161 consecutive patients with idiopathic scoliosis at the authors' institution. OBJECTIVES: To compare various radiographic findings that directly affect surgical decision-making and the evaluation of postsurgical outcomes to determine the usefulness of information gathered from radiologists' multiple duplicate reading of films. SUMMARY OF BACKGROUND DATA: To the authors' knowledge, there are no previous studies on the readings of scoliosis films by radiologists and surgeons. METHODS: The patient pool was drawn from the private practices of two board-certified orthopaedic surgeons. Each set of radiographs was read by one of seven board-certified radiologists and by one of the two surgeons. The two reports of each radiograph were compared. The factors included in the reports were scoliosis deformity, scoliosis type, curve progression, curve magnitude, levels of the curve, kyphosis, lordosis, the presence of instrumentation, and the presence of a fusion. RESULTS: The radiologists and orthopedic surgeons mentioned the presence of scoliosis in 95% and 99.4% of their reports, respectively. The type of scoliosis was mentioned in 5% of reports by radiologists and in 99.4% by orthopedists. Progression of the curve was documented in 16.7% of the radiologists' reports and in 98.4% of orthopedists' reports. The magnitude of the curve was stated in 12.6% of the radiologists' reports, compared with 98.1% of the orthopaedists' reports. The levels of the curve were documented in 10.6% and 95.6% of reports by the radiologists and orthopedists, respectively. Radiologists mentioned kyphosis and lordosis in 28% and 26.5% of reports, respectively. These same two entities were mentioned in 98.2% and 79.4% of reports by the orthopedists. Finally, the radiologists noted the presence of instrumentation and of a fusion in 77.8% and 68.3% of reports, respectively. Orthopedists mentioned these same two entities in 84.4% and 100% of reports, respectively. In the radiologists' reports on the presence of instrumentation, 20% were mislabeled or improperly identified. Seven percent of the fusions documented by the radiologists were incorrect because they were recorded before biologic fusion could have taken place. In all these categories, the radiologists provided information in excess of the orthopedic reports a total of 1.9% of the time. Of this 1.9% additional information, 36.8% was incorrectly read or mislabeled. The other 63.2% of the additional information (1.9% of the total) did not elucidate anything of real clinical significance that was missed by the orthopedic surgeons (e.g., a tumor in the lung). CONCLUSIONS: These findings show that the attending orthopedic spine surgeons gained little useful information from the radiologists' multiple duplicate reading of films.

Humans↗

PubMed1999

Jarcho-Levin syndrome: report on a long-term follow-up of an untreated patient.

Jarcho-Levin syndrome is a genetically transmitted rare entity characterized by multiple vertebral and rib anomalies. The multilevel skeletal involvement causes short stature, neck and thoracic cage deformities, and restrictive lung disease that is usually the cause of early death. The authors describe a 33-year follow-up of a patient with this syndrome who represents, to their best knowledge, the longest survival of a patient with this entity.

Abnormalities, Multiple↗

PubMed1999

Pyogenic vertebral osteomyelitis.

Pyogenic vertebral osteomyelitis is defined as a primary infection in the osseous elements of the spine by pyogenic organisms with secondary involvement of the intervertebral disc and adjacent soft tissue or epidural space. Epidemiology and pathogenesis, clinical presentation, diagnosis, treatment and prognosis are briefly reviewed in this article.

Diagnosis, Differential↗

PubMed1998

Chance fracture after pedicle screw fixation. A case report.

STUDY DESIGN: A case of a Chance fracture through an instrumented pedicle is presented. The radiographic and intraoperative findings and management of this complication are reported. OBJECTIVE: To increase awareness of the complications of transpedicular screw fixation and to suggest a form of management of this unusual complication. SUMMARY OF BACKGROUND DATA: To the authors' knowledge, this is the first reported case of such a vertebral fracture occurring after pedicle screw fixation. METHODS: A 44-year-old man with athetoid cerebral palsy and a progressive thoracic kyphosis sustained a Chance fracture at the caudal end of the segmental instrumentation construct. RESULTS: Surgical intervention, including fracture reduction and extension of the instrumented fusion to the pelvis, provided effective restoration of physiologic sagittal alignment. CONCLUSION: Chance fracture after pedicle screw fixation can be successfully managed with surgical intervention.

Adult↗

PubMed1998

Lumbar fusion results related to diagnosis.

STUDY DESIGN: Pain outcome and functional outcome after primary lumbar fusion surgery were determined by a self-assessment questionnaire. The responses were correlated with various clinical parameters. OBJECTIVES: To determine the result of fusion surgery among patients in various diagnostic groups using semiquantitative outcome scales. SUMMARY OF BACKGROUND DATA: Most previous studies on the results of primary lumbar fusion have reported the presence of pain, but few have addressed function outcomes. Results of a literature review were inconclusive as to whether a patient's diagnosis is a predictor of improved results. METHODS: During the 3-year period from 1988 to 1990, 165 patients underwent a primary lumbar fusion procedure. They had a chart and radiograph review and were categorized into five major diagnostic groups: 1) pediatric, 2) grade I-II spondylolisthesis (low-slip), 3) grade III-IV spondylolisthesis (high-slip), 4) degenerative disc disease, and 5) postdiscectomy. At a follow-up period of 5 years (mean) after the fusion, patients were mailed a questionnaire in which they described their pain and functional status before and after their lumbar fusion surgery. Questionnaires were returned by 92% of the patients. The questionnaire scores, complications, and revision procedures were grouped by patient diagnosis and analyzed. RESULTS: Patient satisfaction with the results of primary lumbar fusion ranged from 69% (for the postdiscectomy group) to 100% (for the pediatric and high-slip groups). For all diagnostic groups, lumbar fusion resulted in a significant decrease in back pain and leg pain (visual analog scale), which was maintained throughout the follow-up period. For back pain, the pediatric and high-slip groups showed significantly more improvement than the degenerative disc disease or postdiscectomy groups. Leg pain among patients in the pediatric and high-slip groups was significantly more improved than leg pain among patients in the low-slip, degenerative disc disease, or postdiscectomy groups. There was no deterioration of pain scores during the follow-up period. After fusion, all groups had a significant decrease in Oswestry disability scores; patients in the pediatric and high-slip group had significantly more improvement than patients in the degenerative disc disease or postdiscectomy groups. High- and low-slip groups had a significant improvement in their pain drawing score. Medication use was substantially reduced in all groups. After fusion, a lack of improvement in back pain score or disability score was significantly correlated with pseudarthrosis. CONCLUSIONS: The outcome of primary lumbar fusion surgery was decreased pain and increased function for the majority of patients in all five diagnostic categories. The amount of improvement varied by diagnostic group. Patients with developmental conditions showed greater improvement than patients with degenerative conditions.

Adolescent↗

PubMed1998

Rheumatoid arthritis of the cervical spine.

Rheumatoid arthritis most often affects the cervical spine, resulting in clinical and radiographic findings. For most patients with rheumatoid arthritis the cervical involvement represents a relatively benign process, but, in a small percentage of these patients, a progressive instability pattern develops that may compromise neural or vascular structures. The rate of neural compromise because of cervical instability ranges from 11% to 58%. The clinical manifestation may be radiculopathy, myelopathy, quadriplegia, and, in extreme instances, sudden death.

Arthritis, Rheumatoid↗

PubMed1997

Rotational changes of the vertebral pelvic axis after sublaminar instrumentation in adolescent idiopathic scoliosis.

STUDY DESIGN: The authors studied the rotational effect of sublaminar wiring on the spinal pelvic axis on 20 patients who were being treated for adolescent idiopathic scoliosis. OBJECTIVES: To determine if sublaminar wiring effectively derotates the scoliotic spine. SUMMARY OF BACKGROUND DATA: The correction of the rotational deformity in adolescent scoliosis via sublaminar wiring is not well quantified in the literature. The derotation maneuver of Cotrel-Dubousset has been shown to produce variable and unpredictable amounts of axial derotation. METHODS: Twenty patients who underwent posterior spine fusion for adolescent idiopathic scoliosis were evaluated using computed tomography scans and plain radiography before and after surgery and at a subsequent follow-up examination (average time of follow-up examination, 35 months after surgery). The degree of angle of vertebral rotation about the sagittal plane and that relative to the pelvis were measured before and after surgery and at a follow-up examination. RESULTS: The primary thoracic curves were not derotated significantly relative to the pelvis with sublaminar wiring. Primary thoracolumbar curves instrumented on the convexity with pedicle screws were derotated significantly relative to the pelvis (P = .001). The average initial correction was 57%. On final follow-up examination, the correction was 24% (18 of 20 twenty individuals lost axial correction by an average of 34%). In nine of 20 patients the spine was more rotated, relative to the pelvis, than it had been before surgery. No coronal or sagittal decompensation was seen in any curve type. CONCLUSIONS: Coronal and sagittal plane correction of scoliotic curves may be achieved with sublaminar instrumentation. The ability to derotate axially the scoliotic spine appears to be variable, however, and, in most cases, curve-type dependent. Over time, much correction appears to be lost, and in many patients the scoliosis actually becomes worse than it was before surgery. Nonetheless, the apical derotation that takes place appears to be reasonably true: the percent correction of angle of rotation about the sagittal plane and the percent correction of angle of rotation about the sagittal plain relative to the pelvis were closely correlated. Derotation forces applied to the instrumented spine do not appear to be transmitted to more distal segments.

Adolescent↗

PubMed1996

Thoracic volume changes in scoliosis surgery.

STUDY DESIGN: Eighteen patients with adolescent idiopathic scoliosis treated with ISOLA instrumentation and 13 treated with Cotrel-Dubousset instrumentation were studied before and after surgery with computed tomography scans. OBJECTIVES: To analyze and compare the immediate change in chest volume of patients treated with the derotation method of Cotrel-Dubousset versus the sublaminar wire translational technique of ISOLA. SUMMARY OF BACKGROUND DATA: Previous literature suggests a small but variable improvement in pulmonary function with the use of Harrington instrumentation when treating adolescent idiopathic scoliosis. The effect of modern instrumentation techniques on chest volume and ultimately pulmonary function has not been determined. METHODS: An axial computed tomography slice was made through each vertebral body from T3 to T10. Using a technique of spine curve measurements, the cross-sectional area at each level was computed, and from the height measured, the volume of the thoracic cage was computed. RESULTS: Single thoracic curves (King-Moe Type III) managed with ISOLA sublaminar instrumentation showed a statistically significant increase in chest volume when compared with other curve types and when compared with all curves managed with Cotrel-Dubousset. Seventeen of 18 patients treated with ISOLA instrumentation gained chest volume, whereas half of those treated with Cotrel-Dubousset actually lost volume. CONCLUSIONS: ISOLA instrumentation and sublaminar wiring appears to increase the chest volume in patients with adolescent idiopathic scoliosis. Its clinical significance remains to be determined.

Adolescent↗

PubMed1996

Spinal deformity.

Spinal deformity in children has a wide range of causes. The most common entities are idiopathic scoliosis, postural roundback, and Scheuermann's kyphosis. The pediatrician, primary care physician, and orthopedic surgeon can optimally treat these disorders with close observation, attention to detail, initiation of bracing when indicated, and surgery on patients who have an appropriate indication. A careful, well-planned approach to these conditions results in the successful treatment of spinal deformities with minimal complications. The physiologic and psychological sequelae of these entities can then be minimized, preserving the overall health of the child.

Adolescent↗

PubMed1996

Tuberculosis of the spine.

Chemotherapeutic agents remain the cornerstone of treatment for spinal tuberculosis. The arguments that surgery is necessary for biopsy and to allow for removal of infection and its byproducts have been usurped by advanced biopsy techniques and trials demonstrating resolution of infection and most abscesses using chemotherapy. Although chemotherapy alone has been demonstrated to be effective for some neurologic deficits, those lesions that may be safely treated without surgery remain to be fully defined. Modern imaging techniques have allowed more precise diagnosis and identification of neural compression and the extent of bony involvement. Refinement and popularization of anterior surgical techniques have made decompression and reconstruction relatively safe in experienced hands. Lesions that possess a propensity towards kyphosis are more readily identifiable. The use of instrumentation in the face of active disease appears to be promising, though at present there is a relative paucity of supporting data. Despite these advances in treatment, it must be borne in mind that ultimately, the diagnosis of this relatively uncommon disorder must precede the treatment.

Abscess↗