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Biomedical subjects

R B Winter

Publications and source records attributed to R B Winter.

At least 145 records · Page 8Linked to original sources
PubMed1979

Spine deformity in neurofibromatosis. A review of one hundred and two patients.

The natural history, associated anomalies, and response to operative and nonoperative treatment were reviewed in 102 patients with neurofibromatosis and spine deformity. Eighty patients were found to have curvatures associated with dystrophic changes in the vertebrae and ribs. The presence of dystrophic changes such as rib penciling, spindling of the transverse processes, vertebral scalloping, severe apical vertebral rotation, foraminal enlargement, and adjacent soft-tissue neurofibromas was found to be highly significant in prognosis and management. Brace treatment of dystrophic curves was unsuccessful. Posterior fusion, with or without internal fixation, was the procedure of choice for problems due purely to scoliosis. Patients with dystrophic kyphoscoliosis required both anterior and posterior fusion to achieve stability. Sixteen patients had compression of the spinal cord or cauda equina.

Adolescent↗
PubMed1979

Management of severe spondylolisthesis in children and adolescents.

Forty-three patients with a fifth lumbar-first sacral spondylolisthesis of 50 per cent or greater were reviewed. Four had been treated non-operatively; eleven, by arthrodesis; eighteen, by decompression and arthrodesis; and ten, by reduction and arthrodesis. The angle of slipping (measurement of the kyphotic relationship of the fifth lumbar to the first sacral vertebra) was found to be as important a measurement as the percentage of slipping in measuring instability and progression of slipping. Hamstring tightness did not correlate with neural deficit. Arthrodesis alone, even in the presence of minor neural deficits, tight hamstrings, or both, gave relief of pain and resolution of neural deficits and tight hamstrings. Our experience with a limited number of patients suggests that management by postoperative extension casts may achieve a significant reduction in percentage of slipping and in angle of slipping. Progression of the spondylolisthesis may occur following a solid arthrodesis.

Achilles Tendon↗
PubMed1979

Reconstructive surgery in the adult for failed scoliosis fusion.

Fifty-nine adult patients were examined who had undergone previous spine surgery for scoliosis but in whom pain (78 per cent), loss of correction (68 per cent), or dyspnea (36 per cent) subsequently developed. Twenty-six patients had idiopathic scoliosis, twenty-five had paralytic scoliosis secondary to poliomyelitis, and eight had scoliosis secondary to miscellaneous etiologies. A one-stage reconstructive procedure was performed in sixteen patients and a two-stage procedure, in forty-three patients. The two-stage procedure consisted of exposure of the spine and multiple osteotomies, followed by two weeks of halofemoral traction to obtain correction. The spine fusion was then extended, using Harrington instrumentation to maintain correction. At an average follow-up of 3.3 years there was reduction of pain in 67 per cent of the patients and a solid fusion in all but two. The complication rate was high (71 per cent), the most important complications being pseudarthrosis, wound infection, urinary tract infections, loss of lumbar lordosis, and pressure sores. The mortality rate was 3.4 per cent. No patient became paraplegic at the initial surgical procedure and early recognition and treatment of pseudarthrosis will reduce the number of patients requiring this salvage operation.

Adult↗
PubMed1978

Combined Dwyer and Harrington instrumentation and fusion in the treatment of selected patients with painful adult idiopathic scoliosis.

Five patients with painful adult idiopathic scoliosis and double structural curve patterns were treated by combined Dwyer and Harrington instrumentation and fusion. The goal of treatment, achieved in all 5 cases, was elimination of pain, stabilization of the spine, and restoration of torso balance. The thoracic curve was corrected an average of 24%, and the lumbar curve, 46%. The loss of correction was only 5 degrees at followup. There were no pseudoarthroses and no complications.

Adult↗
PubMed1978

Kyphosis in childhood and adolescence.

Kyphosis has become an increasingly important problem to the surgeon interested in the management of significant spinal deformity. As scoliosis has become better understood, the more difficult problems have become apparent and one of the most difficult of these is kyphosis. Kyphosis is the deformity which can produce paraplegia if it progresses to a significant degree and remains untreated. Contrary to scoliosis, in which bracing and posterior fusion alone are usually quite sufficient, kyphosis sometimes responds to bracing and other times it does not. If surgical treatment is necessary it quite often requires an anterior fusion. The purpose of this presentation is to give an overall review of the various etiologies of kyphosis and the current status of management of these various problems.

Adolescent↗
PubMed1978

Complications after cuneiform osteotomy for moderately or severely slipped capital femoral epiphysis.

Wedge osteotomy of the femoral neck for slipped capital femoral epiphysis was performed in seventy-seven hips of seventy-one children at Gillette Children's Hospital during the period 1938 to 1973. The major complications were avascular necrosis (28.5 per cent) and cartilage necrosis (37.6 per cent). This high incidence of severe complications led to the use of an osteotomy through the base of the neck for the treatment of severely slipped capital femoral epiphysis which has given satisfactory results in six hips to date.

Adolescent↗
PubMed1978

Congenital thoracic lordosis.

The rare spinal deformity of congenital thoracic lordosis is illustrated in five patients. Often this deformity is progressive and may cause severe pulmonary deficits and death. In the two patients most recently treated, early spine fusion (one anterior and one posterior) showed promising results--halting of the progression of deformity and even some amelioration of the lordosis. In two patients in whom active attempts were made to correct the lordosis, the complications were severe--one patient died and quadriparesis developed in the other.

Adolescent↗
PubMed1978

Scoliosis, spondylolysis, and spondylolisthesis. Their relationship as reviewed in 539 patients.

Five hundred consecutive idiopathic scoliosis patients in whom routine oblique roentgenograms of the lumbosacral area were obtained, plus 39 patients with a presenting problem of spondylolisthesis, were reviewed in an attempt to answer questions concerning the best therapeutic approaches in patients having coincident scoliosis and pars defects. The incidence of pars defects in patients with idiopathic scoliosis was found to be 6.2%, slightly higher than in the white female population at large. The indications for a surgical approach to the pars defect and/or the spinal curvature parallel the indications for each problem arising independently.

Adolescent↗
PubMed1977

Techniques of anterior spinal surgery for the management of kyphosis.

Experience with the techniques of spinal surgery for the management of thoracic and lumbar kyphosis suggests that the anterior approach is useful for correcting fixed deformity (achieving solid arthrodesis and decompressing the spinal cord when necessary). The insertion of an anterior bone graft alone does not guarantee a solid arthrodesis. Meticulous technique, autologous bone, and efficient immobilization are essential for a satisfactory result.

Abdomen↗