Thirty-two pediatric patients with severe restrictive lung disease identified with vital capacities < 40% of predicted, who had undergone major reconstructive spine surgery, were reviewed. There were 18 boys and 14 girls, the mean age was 13 years (range, 7-17), and the mean vital capacity was 31% of predicted (range, 16-39%). Fifty-four procedures were performed, 13 posterior only, one of which was staged, and 19 anterior and posterior procedures, of which 15 were staged and four were sequential. The incidence of pulmonary complications (pneumonia, reintubation, pneumothorax, respiratory arrest, or the need for tracheostomy) was 19% (six patients), and only three patients required tracheostomy. The surgical and perioperative mortality rate was zero. Patients who had a thoracotomy or a thoracoabdominal approach had a significantly higher number of pulmonary complications. The use of preoperative decreased vital capacity as a measure of inoperability excludes the young patient most in need of surgical intervention. With improved preoperative, intraoperative, and postoperative techniques, careful monitoring, and the cooperation of pediatric pulmonologists and intensivists, reconstructive spine surgery can be performed in the pediatric patient with severe decreased vital capacity with very acceptable morbidity and mortality.

Adolescent↗

PubMedDate not supplied

Determination of "normal" thoracic kyphosis: a roentgenographic study of 121 "normal" children.

The purpose of this prospective study was to determine the range of "normalcy" in the radiologic measurement of thoracic kyphosis in children by using a standardized position and full-length radiograph in 121 normal children. Using +/- two standard deviations from the mean as the definition of "normal," a range of 20 degrees - 50 degrees was determined. There was no difference between the various age subgroups or between genders.

Adolescent↗

PubMedDate not supplied

Neurologic deficits secondary to spinal deformity. A review of the literature and report of 43 cases.

Forty-three cases of neurologic complications of untreated spinal deformities are reviewed. Kyphosis, averaging 95 degrees, was present in all but one patient. The most common deformity was a congenital kyphosis, present in 17 patients. The complication was more common in males, in the presence of thoracic deformities, and in the second decade. Treatment consisted of anterior spinal cord decompression in 25 patients, laminectomy in ten, Capener decompression in six, correction and fusion in five, and Hyndman-Schneider decompression in three. Laminectomy gave the worst results; six of ten patients who received this treatment showed deterioration. Anterior cord decompression gave the best results, with 16 of 25 showing improvement. A treatment plan for this complication is proposed. A plea for prevention is made, as it is far preferable to avoid this dreaded complication by early fusion of kyphotic problems.

Adolescent↗

PubMedDate not supplied

Congenital cervical scoliosis with unilateral congenital nerve deficit in the upper extremity. Report of two cases.

Two patients are reviewed, each having an unusual clinical syndrome of progressive congenital cervical scoliosis and unilateral arm paralysis. This appears to be a unilateral developmental defect in both mesenchymal and neural tissue. There was a unilateral spina bifida without myelomeningocele, meningocele, or lipoma. The cervical spine deformity was progressive at a young age, one patient having been fused at age 2 years, the other at age 5 years. At surgery, the dura was intact but unprotected on the concavity of the curve. Bridging bone grafts were utilized to span the defects. The arm paralysis was extensive in both patients, but improvement in function was accomplished by appropriate reconstructive procedures.

Adult↗

PubMedDate not supplied

Anterior spinal cord decompression and spine stabilization for metastatic disease. A case report.

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Adult↗