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Biomedical subjects

R B Winter

Publications and source records attributed to R B Winter.

At least 199 records · Page 11Linked to original sources
PubMedDate not supplied

Scoliosis and cor pulmonale.

Twenty patients with cor pulmonale due to scoliosis and associated spine deformities seen at the Twin Cities Scoliosis Center in the past 20 years have been reviewed. The average age was 37 years. The average scoliosis was 135 degrees and ranged from 90 degrees to 200 degrees. Fifteen patients were placed in halo traction, nine of whom went on to surgical stabilization. Of the nine patients having surgical treatment, five had postpoliomyelitis curves, two had congenital, one had infantile idiopathic, and one had frontometaphyseal dysplasia. The best results were in the postpoliomyelitis group, with an average pretreatment vital capacity of 595 cc and posttreatment vital capacity of 1071 cc; the average PaO2 increased from 55 to 64 mm Hg, and the average PaCO2 decreased from 52 to 43 mm Hg. The only death in the postpoliomyelitis group occurred six years postoperatively. Of the four nonpoliomyelitis patients having surgery, only one survived, the patient with frontometaphyseal dysplasia. The difference between the poliomyelitis and nonpoliomyelitis groups was striking. Patients with cor pulmonale due to spine deformity should have careful evaluation and a trial of halo traction. If the vital capacity improves, the PaO2 increases, and the PaCO2 decreases, then surgical stabilization can often be successfully accomplished. If these parameters do not improve in traction, then surgical treatment can be abandoned.

Adult↗
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Spinal deformities in patients with spinal muscle atrophy: a review of 36 patients.

Thirty-six patients diagnosed as having spinal muscle atrophy were reviewed. The process was usually recognized in infancy, and spinal deformity commonly developed by age 6, kyphosis developed before age 3, and scoliosis or kyphoscoliosis thereafter. Orthotics may slow progression in most cases, but very young patients must be carefully monitored for chest-wall deformity. Surgery was utilized to stabilize orthotically uncontrollable curves, orthotically controlled curves after maturation, and the severely involved when risks were acceptable. Complications were noted in older or more deformed patients and less frequently in younger, less involved ones. A stabilized spine with head centered over pelvis was usually achieved.

Adolescent↗
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The incidence of Klippel-Feil syndrome in patients with congenital scoliosis and kyphosis.

A retrospective review of the radiographs of 1215 patients with congenital scoliosis and kyphosis disclosed 298 (25%) to have segmentation defects in the cervical spine. A single level defect was seen in 82 patients, 52 of which were at C2-C3. Of the 298 patients, 235 had scoliosis, (6 cervical, 42 cervicothoracic, 75 thoracic, 4 thoracolumbar, and 1 lumbar), 36 had kyphoscoliosis, 10 lordoscoliosis, and 17 pure kyphosis.

Child↗
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Adult idiopathic scoliosis treated by posterior spinal fusion and Harrington instrumentation.

Ninety-one patients with idiopathic scoliosis, who underwent posterior spinal fusion and instrumentation from January 1977 to December 1982, were reviewed. All patients were 20 years or older at the time of surgery and none had undergone a prior surgical procedure. Indications for surgery included pain, progressive deformity, and pulmonary symptoms. All patients had a posterior spinal fusion with Harrington instrumentation and autogenous iliac bone graft, with the addition of segmental wiring in only eight. No patient had an anterior fusion or fusion to the sacrum. Follow-up averaged 3.5 years (range: 2-7 years). The average correction at the time of surgery was 38%, and 32% at the time of last follow-up. Seventy-nine percent of the patients reported complete relief of the symptom(s) for which they had surgery. There were 34 complications in 30 (33%) patients. Pseudarthrosis occurred in 14 (15%), requiring 15 additional procedures to achieve a solid arthrodesis. Urinary tract infection occurred in 8 (9%) patients and Harrington hook dislodgement in 5 (5%). One patient sustained a partial paraparesis with recovery to a minimal deficit. No deaths occurred. Although largely successful, posterior fusion with Harrington instrumentation for adult scoliosis has a significant incidence of pseudarthrosis and instrumentation problems.

Adult↗
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Scoliosis due to epilepsia partialis continua.

A case is reported of scoliosis in a boy with epilepsia partialis continua, an unusual disorder with virtually constant episodes of seizures of only part of the body. The scoliosis appeared to be due to the seizure disorder. The epilepsy seriously inhibited conventional scoliosis management. The patient's scoliosis problem was finally solved by salvage surgery and intensive seizure medication supervision. Scoliosis management in complex seizure disorders presents special and unusual problems.

Anticonvulsants↗
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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↗
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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↗
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The Heyman-Herndon tarsometatarsal capsulotomy for metatarsus adductus: results in 48 feet.

Forty-eight Heyman-Herndon tarsometatarsal capsulotomies were performed over an 18-year period for idiopathic metatarsus adductus and residual adductus of clubfoot. There was a 41% overall failure rate and a 50% incidence of painful dorsal prominence at the surgical scar. Sixty-eight percent of the patients had difficulty with proper shoe fitting. Those with associated orthopedic anomalies were at high risk for a poor result. We believe that tarsometatarsal capsulotomy is of questionable benefit in treatment of forefoot adduction deformities of children.

Child↗
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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↗
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Spinal abnormalities in camptomelic dysplasia.

Significant spinal abnormalities were found in eight patients (average age of 6 years, 5 months) with camptomelic dysplasia. The late ossification of the midthoracic pedicles served as a clear diagnostic criterion for the syndrome. Scoliosis averaging 63 degrees was found in all seven nonquadriplegic cases. Thoracic hyperkyphosis averaging 126 degrees was seen in six (75%) of the patients, while cervical kyphosis averaging 66 degrees was noted in three (38%). Vertebral body hypoplasia appeared to be a major cause of deformity. This study clarifies that patients with camptomelic dysplasia are surviving longer than previously expected and therefore should have their spinal deformities treated aggressively.

Adolescent↗
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Surgical correction of congenital thoracic lordosis.

A 13-year-old girl with rigid congenital thoracic lordosis and congenital scoliosis was treated by a three-stage procedure of anterior transthoracic closing wedge osteotomies, posterior osteotomies of the laminar synostosis, correction of the deformity by sublaminar wires pulled back to a kyphotic bent Luque rod, and a later "pulling-out" procedure on the lateral chest wall.

Adolescent↗
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Congenital absence of the lumbar spine and sacrum: one-stage reconstruction with subsequent two-stage spine lengthening.

This is a case report of a child born with severe, type IV lumbosacral agenesis. At age 6 years, she had surgical reconstruction of her absent spine and thoracic-pelvic instability with Harrington rods and autogenous bone obtained from simultaneous bilateral knee disarticulations. This arthrodesis healed solidly, and at the age of 10 years 6 months and again at age 12 years 6 months, she underwent spine lengthening by osteotomy and distraction instrumentation, the first time with Moe rods and the second time with Cotrel-Dubousset rods. Both lengthening osteotomies healed without difficulty. The spine lengthening achieved was 5.0 cm.

Bone Lengthening↗
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Spine deformity in spondyloepimetaphyseal dysplasia.

Spondyloepimetaphyseal dysplasia is a rare skeletal dysplasia frequently associated with severe spinal deformity. These deformities can appear early in life. They progress rapidly and are potentially lethal. Two treated patients are described, both with severe progressive kyphoscoliosis. The first patient failed to obtain a solid fusion and died of cor pulmonale at age 23 years. The second patient had successful spine fusion with a follow-up of 7 years.

Adolescent↗
PubMedDate not supplied

Anatomy of the achondroplastic lumbar canal.

The narrowed bony canal in the achondroplastic spine cases varied neurologic problems. The specific anatomic areas seem not to have been directly measured in an autopsy specimen. An achondroplastic spine was examined radiographically and found to show decreased interpediculate distance, thick pedicles, inferior facet thickness, and for animal stenosis in the lumbar canal. These findings have direct application to surgical treatment insofar as simple laminectomy for achondroplastic dwarfs may be insufficient to produce neural canal decompression. The problem is likely to require thorough exposures of facets and foramen.

Achondroplasia↗