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Biomedical subjects

R B Winter

Publications and source records attributed to R B Winter.

207 records · Page 12Linked to original sources
PubMedDate not supplied

Modern orthotics for spinal deformities.

Four basic types of orthoses are now being used at the Twin Cities Scoliosis Center for the treatment of spinal curvatures. The Milwaukee Brace, either custom-made or using a prefabricated pelvic section is the orthosis of choice for thoracic scoliosis and kyphosis in the ambulatory child. For lumbar and thoracolumbar curves, the one-piece "TLSO" has proven the most effective design. For the collapsing spine of myelomeningocele, childhood paraplegia, and spinal muscular atrophy, the 2-piece bivalved polypropylene body jacket is excellent. For the severely involved cerebral palsy or Duchenne Dystrophy patient, the Chair Insert type Sitting Support Orthodosis is preferable.

Braces↗
PubMedDate not supplied

Severe neurofibromatosis kyphoscoliosis in a Jehovah's Witness. Anterior and posterior spine fusion without blood transfusion.

A case is presented of a 22-year-old female Jehovah's Witness with severe kyphoscoliosis, who was successfully treated surgically by carefully staged posterior and anterior spine fusions completed with the use of intraoperative hemodilation techniques. Three spinal procedures were carried out at intervals, and no blood transfusion was given at any of them.

Adult↗
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

Scheuermann's kyphosis: a form of osteoporosis?

A high frequency of abnormalities were noted in radiographic measurements of bone density, microradiography of the iliac crest, serum alkaline phosphatase, urinary hydroxyproline and dietary calcium intake in 12 patients with Scheuermann's juvenile kyphosis. Scheuermann's kyphosis may be a manifestation of generalized skeletal disease which becomes symptomatic during the growth spurt of puberty.

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↗
PubMedDate not supplied

Spinal instrumentation without fusion for progressive scoliosis in young children.

Between 1973 and 1993, a heterogeneous group of 67 children with progressive scoliosis entered a program of incremental-distraction spinal instrumentation without fusion supplemented by full-time external orthotic support. Over the course of treatment, curve magnitude improved from an average of 67 degrees at initial instrumentation to 47 degrees at definitive fusion. For all patients, curve response tended to decline with consecutive procedures. The measured growth of the instrumented but unfused spinal segments averaged 3.1 cm over a mean treatment period of 3.1 years. The results of our study suggest that spinal instrumentation without fusion can control progressive scoliosis in a majority of children while allowing normalized growth of instrumented spinal segments. The mean duration of treatment and ultimate gain in spinal length are constrained by progressive structural changes that alter curve response to incremental distraction. Despite these limitations, spinal instrumentation without fusion may provide a reasonable management alternative when individualized among these difficult patients.

Adolescent↗