Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “SCOLIOSIS”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 739 records · Page 41Linked to original sources
PubMed1997

A comparison between the Boston brace and the Charleston bending brace in adolescent idiopathic scoliosis.

STUDY DESIGN: The authors studied 319 patients with adolescent idiopathic scoliosis treated at the same institution with either a Boston brace or a Charleston bending brace. OBJECTIVES: To determine if both orthoses are equally effective in stopping curve progression and preventing the need for surgical correction. SUMMARY OF BACKGROUND DATA: Early reports suggest that the Charleston brace may be comparable to the Boston brace in its effectiveness and that both braces positively influence the natural history of idiopathic scoliosis. METHODS: Skeletally immature (Risser 0, 1, or 2) patients with idiopathic scoliosis who were 10 years old or older at the time of brace prescription, had curves from 25 degrees to 45 degrees, and had no prior treatment were studied retrospectively. All measurements were collected by a single observer, and all patients were followed up to skeletal maturity. RESULTS: The Boston brace is more effective than the Charleston brace, both in preventing curve progression and in avoiding the need for surgery. These findings were most notable for patients with curves of 36 degrees-45 degrees, in whom 83% of the those treated with a Charleston brace had curve progression of more than 5 degrees, compared with 43% of those treated with the Boston brace (p < 0.0001). CONCLUSION: When given the choice between these two orthoses in the treatment of adolescent idiopathic scoliosis, the authors recommend use of the Boston brace. The Charleston brace should be considered only in the treatment of smaller single thoracolumbar or single lumbar curves.

Adolescent↗
PubMed1997

Chiari I malformation associated with syringomyelia and scoliosis.

STUDY DESIGN: A retrospective review of a series of 12 children who underwent suboccipital foraminotomy and duroplasty for Chiari I malformation. OBJECTIVE: To assess the effects of this surgery on associated syringomyelia and scoliosis. SUMMARY OF BACKGROUND DATA: Suboccipital foraminotomy for the treatment of syringomyelia associated with Chiari I malformation was greatly stimulated by Gardner's hydrodynamic theory, and its results proved to be encouraging. However, several authors reported improvement or stabilization of associated scoliosis after this surgery. METHODS: A retrospective review was conducted on 12 patients who underwent suboccipital foraminotomy for Chiari I malformation associated with syringomyelia. Neurologic Impairment, extent of syringomyelia, and severity of associated spinal deformity were assessed preoperatively and at a 4.5-year average follow-up (range, 2.1-12 years). Anomaly of superficial abdominal reflexes was found in all cases, and para or tetraparesis in three cases. Syringomyelia was of variable localization and extent. Scoliosis was present in 7 cases (greater than 40 degrees in 5 cases). RESULTS: Diminution or complete disappearance of syringomyelia was observed in 11 cases, 3 months to 1 year after surgery. Superficial abdominal reflexes anomaly improved in four cases. Minimal neurologic deficit persisted in one case. Scoliosis improved in one case, remained unchanged in one case, and progressed in the five cases with preoperative severe deformity, requiring instrumentation and fusion. CONCLUSIONS: Improvement of syringomyelia and neurologic deficit, observed with suboccipital foraminotomy, supports the theory that abnormal hydrodynamics of the cerebral spinal fluid is most likely to cause these deficits.

Adolescent↗
PubMed1997

Lumbar pedicle screws versus hooks. Results in double major curves in adolescent idiopathic scoliosis.

STUDY DESIGN: A retrospective assessment of the effectiveness of lumbar pedicle screws versus laminar hooks in lumbar curve correction with double major curves in adolescent idiopathic scoliosis. OBJECTIVE: To determine if pedicle screw fixation of the lumbar spine has any advantage compared with multiple laminar hook instrumentation in the treatment of double major curves in adolescent idiopathic scoliosis. SUMMARY OF BACKGROUND DATA: Although hooks have been used most commonly, pedicle screws may offer advantages in correction and maintenance of reduction of the lumbar curve in adolescent idiopathic scoliosis. METHODS: A consecutive series of 39 patients with double major curves underwent thoracic and lumbar instrumentation by a single surgeon. Lumbar pedicle screws and hooks were used in 20 patients (Group S) and in 19 patients only lumbar hooks were used (Group H). Thoracic Cotrel-Dubousset instrumentation with hooks was the same in both groups. Preoperative age, gender, bracing, and Cobb angles were similar in both groups. Preoperative, 1-month postoperative, and latest follow-up standing posteroanterior and lateral spine radiographs were blinded to the surgeon and lumbar instrumentation covered to hide its identity. Measurements included Cobb angles, preoperative flexibility, lumbar and thoracic apical vertebral deviation, and reduction of lateral tilt and lateral displacement of the first free lumbar vertebra below the instrumentation. Percent correction, maintenance of correction at follow-up, and total levels fused were calculated. RESULTS: The mean follow-up was 3.5 years (range, 2-8 years), which was similar for Groups H and S. Pedicle screws appear to offer some advantage in lumbar curve correction, maintenance of correction, and correction of the uninstrumented spine below the fusion when compared with the use of hooks alone. Horizontalization of the first free lumbar vertebra below the instrumentation percent correction of tilt: 62% screws vs. 11% hooks; P = 0.0003), residual tilt (8 degrees screws vs. 17 degrees hooks; P = 0.004), and loss of horizontalization at follow-up (5% screws vs. 26% hooks) were dramatically better for the group using screws. Lumbar curve correction (72% screws vs. 60% hooks; P = 0.026), loss of lumbar curve correction (5% screws vs. 13% hooks), and correction of lateral apical vertebral deviation (2.2-cm screws vs. 1.5-cm hooks or 63% vs. 31%; P = 0.013) were better when screws were used. There was no significant difference in loss of correction of the thoracic curves (35% vs. 37%) or any difference in loss of correction of lateral displacement of the thoracic apical vertebra (12% vs. 14%). There was no difference in total levels fused, operative blood loss, operative time, or ultimate patient outcome. No patients in either group had spinal imbalance at latest follow-up. There were no complications related to pedicle screw placement. Two cases of transient postoperative superior mesenteric artery syndrome (duodenal obstruction by the superior mesenteric artery) in the pedicle screw group are attributed to acute correction of the lumbar scoliosis and thoracolumbar kyphosis with resultant lordosis at the thoracolumbar junction. CONCLUSIONS: Lumbar pedicle screws may offer greater lumbar curve correction, better maintenance of correction, and greater correction of the uninstrumented spine below double major curves. No complications were associated with the placement of pedicle screws.

Adolescent↗
PubMed1997

Delayed postoperative paraparesis in scoliosis surgery. A case report.

STUDY DESIGN: A case report is presented of an unusual complication of scoliosis surgery that, to the authors' knowledge, has never been reported in the literature. OBJECTIVE: Neurologic complications can occur after an uneventful posterior spinal instrumentation and fusion for scoliosis. Careful observation during the post-operative period is crucial for early detection of impending neurologic deficit. SUMMARY OF BACKGROUND DATA: Nerve compression of the cauda equina has been reported as a complication of different types of surgery in the lumbar spine, but an ascending paraparesis has never been described as a complication of scoliosis surgery. METHODS: A 12-year-old boy with a right thoracic scoliosis measuring 68 degrees and a 72 degrees left lumbar curve underwent Cotrel-Dubousset instrumentation and fusion from T5 to L4. Spinal cord monitoring with somatosensory evoked potentials and motor action potential were recorded and stable through out the entire procedure. Thirty hours later, a rapidly progressive ascending para-paresis developed that required urgent decompression. RESULTS: This patient underwent urgent decompression and removal of the Cotrel-Dubousset instrumentation. After surgery, the clinical picture improved gradually, and at 2-month follow-up he had regained normal strength in his lower limbs except for a grade 4 left extensor hallucis longus. By 4 months postdecompression, he had made a total recovery. CONCLUSIONS: Although clinical examination may be difficult to perform in patients who are unconscious, on large doses of narcotic drugs, or mentally retarded, careful observation during the postoperative period and awareness of this complication can allow early detection of impending reversible neurologic deficit and provision of appropriate treatment.

Child↗
PubMed1997

Fiber transformations in multifidus muscle of young patients with idiopathic scoliosis.

STUDY DESIGN: In this study, the authors investigated the superficial multifidus muscle in patients with idiopathic scoliosis. During spinal fusion, biopsies were taken bilaterally at the apex of the curve, and at the upper and lower end vertebrae. OBJECTIVES: To analyze the muscular reactions in response to bracing in patients with idiopathic scoliosis. SUMMARY OF BACKGROUND DATA: The extent to which intervertebral mobility is restricted by an orthosis is still controversial. In addition, the effect of bracing on the erector spinae has not been investigated. METHODS: Of a total 30 patients, 11 had been treated with a corset for a year or more before surgery. Biopsies were investigated histochemically and the muscle fibers classified as Type I, IIA, IIB, or IIC (transitional fibers). The relative distribution of the fibers was calculated and their diameter was measured. RESULTS: In unbraced patients, a shift in the fiber distribution (from "slow" to "fast") was observed exclusively at the concave side of the apex. This shift was paralleled by an increased percentage of the intermediate Type IIC fiber (indicative of fiber transformation). In patients who always wore a corset, the relative amount of Type IIC fibers was increased, without preference for a specific location. CONCLUSIONS: Corset treatment elicits muscle fiber transformation processes at different levels along the scoliosis. This general reaction of the paraspinal muscles provides strong evidence against the existence of muscular disorders that are restricted to the area of the apex and are thus causing the scoliosis. As such, it must be assumed that the muscular changes in the apical region are secondary.

Adenosine Triphosphate↗
PubMed1997

Interpretation and utility of traction radiography in scoliosis surgery. Analysis of patients treated with Cotrel-Dubousset instrumentation.

STUDY DESIGN: An analysis of a standardized method of traction radiography for the evaluation of reducibility of scoliosis. OBJECTIVES: To determine whether and how preoperative fraction radiography can provide objective information and to compare traction radiography with supine side-bending radiography. SUMMARY OF BACKGROUND DATA: Flexibility of scoliosis deformity remains an arbitrary concept. No objective method of preoperative evaluation of reducibility has been established. METHODS: The utility of a standardized method of traction radiography was evaluated in 74 patients with idiopathic scoliosis who were aged 14-22 years and treated with Cotrel-Dubousset instrumentation. RESULTS: In thoracic curves, the postoperative Cobb angle was highly correlated with the preoperative Cobb angle in traction (r = 0.82). However, such correlation was much lower with lumbar curves (r = 0.54). The reducibility of the thoracic curve by traction as expressed by the ratio to the original curve was dependent on the magnitude of the original curve (P = 0.005), and this parameter proved less informative than the absolute angle values. Time-related analysis of 30 patients who were observed for more than 5 years revealed that the high correlation between the preoperative angle of thoracic curves in traction and their postoperative angle decreased with the follow-up time (r = 0.80-0.65). A comparison of traction radiography and supine side-bending radiography showed that these two tests were practically equivalent in terms of evaluating the reducibility of curves. CONCLUSION: The results provide an objective interpretation of traction radiographs for scoliosis.

Adolescent↗
PubMed1997

The role of preoperative pulmonary function tests in patients with adolescent idiopathic scoliosis undergoing posterior spinal fusion.

STUDY DESIGN: A retrospective review of the case records and radiographs of 133 patients with adolescent idiopathic scoliosis who underwent posterior spinal fusion and instrumentation between 1986 and 1992. OBJECTIVES: To evaluate the incidence of abnormal results on preoperative pulmonary function tests and their correlation to immediate postoperative pulmonary impairment in patients with adolescent idiopathic scoliosis who had posterior spinal fusion. SUMMARY OF BACKGROUND DATA: It has been stated that preoperative pulmonary function tests are essential to assess surgical risk in a patient with scoliosis because of the possibility of further compromising the pulmonary function. Authors of previous studies have reported on the increased incidence of postoperative pulmonary complications in patients undergoing anterior spinal surgery. METHODS: The case records and radiographs of 133 patients with either a thoracic or a double-major curve, who underwent posterior spinal fusion, were reviewed. The presence of any preoperative or postoperative cardiopulmonary symptoms and increased requirement of postoperative ventilatory support were noted. Results of preoperative pulmonary function tests were classified as normal, restrictive, or obstructive disease. Postoperative chest radiographs were examined to note the presence of atelectasis, infiltrates, pneumothorax, hemothorax, or pneumonia. RESULTS: The majority of patients (72.9%) had normal results on pulmonary function tests. The mean coronal Cobb angle of the thoracic curve was 48 degrees, and the mean angle of kyphosis was 26 degrees. None of the patients had any increased requirement of postoperative ventilatory support. The overall incidence of postoperative pulmonary complications was 2.3%. CONCLUSIONS: Performance of a thoracoplasty was the only risk factor for postoperative pulmonary complications in patients undergoing posterior spinal fusion. There was no correlation between deterioration of preoperative pulmonary function and the risk of postoperative pulmonary complications. It appears that performance of preoperative pulmonary function tests in patients with moderate adolescent idiopathic scoliosis-scheduled for posterior spinal fusion is not necessary.

Adolescent↗
PubMed1997

Matrix metalloproteinases in the human intervertebral disc: role in disc degeneration and scoliosis.

STUDY DESIGN: Biochemical study of human intervertebral discs collected at surgery from patients with low back pain associated with disc degeneration or scoliosis. Matrix metalloproteinases were studied by quantitative zymography. OBJECTIVE: To determine whether changes in the expression of matrix metalloproteinases will bring about tissue remodelling that contributes to the progressive nature and pathology of these diseases of the intervertebral disc. SUMMARY OF BACKGROUND DATA: The diseases of the intervertebral disc, degenerative disc disease and scoliosis, are both characterized by changes in the extracellular matrix components that will affect the mechanical function of the tissue. Matrix metalloproteinases are known to have the capability of degrading all the known extracellular matrix components of the disc. METHODS: Matrix metalloproteinases 2 and 9 were detected by gelatin-gel zymography and quantified by laser scanning densitometry. Both pro and active forms of the enzymes were measured. Thirty-four discs from patients with low back pain and 29 from patients with scoliosis were investigated. RESULTS: A correlation was found between the increasing levels of matrix metalloproteinases 2 and 9 and the grade of degenerative disc disease. In addition, the levels of these enzymes show a differential expression across the scoliotic disc with the highest levels in samples taken from the convexity of the curve. CONCLUSIONS: The difference between the concave and convex side of the scoliotic curve indicates that mechanical loads might influence the expression of these enzymes. The increased expression of these enzymes in both degenerative disc disease and scoliosis strongly suggests that they may affect the progressive nature of these diseases.

Adolescent↗
PubMed1998

Vertebral fracture in a fused spine for scoliosis. A case report.

STUDY DESIGN: A case report. OBJECTIVES: To document a fracture of the 11th thoracic vertebra after spine fusion for adult idiopathic scoliosis. SUMMARY OF BACKGROUND DATA: Three cases of vertebral fractures associated with spine fusion for scoliosis were found in the literature. METHODS: Medical and radiologic records and related literature were reviewed. RESULTS: A 30-year-old woman had undergone anterior and posterior fusion with Cotrel-Dubousset instrumentation for progressive idiopathic scoliosis. Two years after surgery, she was in a car accident. A radiographic study and computer tomographic scanning depicted a fracture of T11 and bending of the rods. Observation was instituted and symptoms resolved. CONCLUSIONS: Fracture of a vertebra within an extensive spine fusion for scoliosis is rare. The 360 degrees solid fusion together with strong posterior instrumentation may have had some protective effect in this patient.

Adult↗
PubMed1998

Somatosensory- and motor-evoked potential monitoring without a wake-up test during idiopathic scoliosis surgery. An accepted standard of care.

STUDY DESIGN: This was a retrospective study of 500 patients undergoing corrective surgery between 1987 and 1997 for spinal deformity caused by idiopathic scoliosis. OBJECTIVES: To report the sensitivity and specificity of somatosensory-evoked and neurogenic motor-evoked potentials monitoring and the requirements for an intraoperative wake-up test for all idiopathic scoliosis surgeries at a single institution. SUMMARY OF BACKGROUND DATA: Intraoperative monitoring is recommended for use during corrective spinal surgery. Accepted monitoring standards and requirements for an intraoperative wake-up test are still debated. METHODS: The study group consisted of 500 patients undergoing corrective surgery for idiopathic scoliosis between 1987 and 1997. All patients were monitored using somatosensory-evoked and neurogenic motor-evoked potential techniques, using a standard protocol developed at this institution. RESULTS: The false-positive rate (significant data change without postoperative neurologic deficit) was 0.014% (n = 7). The true-positive rate (degradation of data that met warning criteria, with a corresponding postoperative neurologic deficit) was 0.004% (n = 2). No false-negative results (normal data during with a postoperative neurologic deficit) were seen. The sensitivity of combined somatosensory-evoked and neurogenic motor-evoked potential data in predicting neurologic status was 98.6%, and the specificity of normal data predicting normal findings in a neurologic examination was 100%. CONCLUSION: Combined somatosensory-evoked and neurogenic motor-evoked potentials monitoring during idiopathic scoliosis surgery represents a standard of care that obviates the need for an intraoperative wake-up test when reliable data are obtained and maintained.

Adolescent↗
PubMed1998

A comparative study of TLSO, Charleston, and Milwaukee braces for idiopathic scoliosis.

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To determine which of TLSO, Charleston, or Milwaukee bracing best prevents curve progression and surgery in adolescent idiopathic scoliosis. SUMMARY OF BACKGROUND DATA: Bracing has been shown to prevent curve progression in idiopathic scoliosis, when compared with no treatment. However, there is little literature available comparing the effectiveness of different brace designs. METHODS: One hundred seventy patients who completed brace treatment for adolescent idiopathic scoliosis between 1988 and 1995 were studied. Forty-five thoracolumbosacral orthoses, 95 Charleston braces, and 35 Milwaukee braces were used. Thoracolumbosacral orthoses and Charleston braces were used on comparable curves, whereas Milwaukee braces were used in a subgroup in which the other brace designs were considered inappropriate. Evaluated were the absolute increase in curve severity, the percentage of curves that progressed beyond 6 degrees and 10 degrees thresholds, and the percentage of patients who underwent surgery. RESULTS: Age, Risser stage, curve size, and time braced and observed did not differ among groups. Mean progression of the curve during bracing was 1.1 degrees with thoracolumbosacral orthosis, 6.5 degrees with the Charleston brace, and 6.3 degrees with the Milwaukee brace (P = 0.012; analysis of variance). Proportion of patients with more than 10 degrees of curve progression was 14% with thoracolumbosacral orthosis, 28% with the Charleston brace, and 43% with the Milwaukee brace (P = 0.017; chi-square). The proportion of patients who underwent surgery was 18% with thoracolumbosacral orthosis, 31% with the Charleston brace, and 23% with the Milwaukee brace (P = 0.26; chi-square). CONCLUSIONS: The thoracolumbosacral orthosis was superior at preventing curve progression in adolescent idiopathic scoliosis.

Adolescent↗
PubMed1999

Effects of deamino-8-D-arginin vasopressin on blood loss and coagulation factors in scoliosis surgery. A double-blind randomized clinical trial.

STUDY DESIGN: A double-blind, randomized, prospective clinical study was performed to evaluate the efficacy of deamino-8-D-arginin vasopressin in reducing blood loss in major scoliosis surgery. OBJECTIVES: To evaluate whether desmopressin has any effect on reducing blood loss in spinal surgery, to identify the probable mechanisms of effectiveness via blood coagulation factors, and to outline any adverse effect associated with the use of deamino-8-D-arginin vasopressin. SUMMARY OF BACKGROUND DATA: Scoliosis surgery is known to be associated with major blood loss. Because of major drawbacks of homologous blood transfusion, many alternative methods have been used to counter the blood loss. Only a few studies exist, with controversial results, on the use of deamino-8-D-arginin vasopressin. METHODS: The study population included 40 operations on 35 consecutive patients undergoing reconstructive surgery for either idiopathic (n = 26) or congenital (n = 9) scoliosis. Operations were randomized into deamino-8-D-arginin vasopressin (0.3 microgram/kg body weight; maximum, 20 micrograms) (n = 18) or placebo (n = 22) groups and stratified according to the diagnosis and the type of surgery performed (i.e., anterior versus posterior versus anterior and posterior sequential). Parameters of blood loss, serum levels of blood coagulation factors at different time intervals, and urinary output were measured. RESULTS: Findings indicated that blood loss per kilogram of body weight, blood loss per surgically treated spinal level, urinary output per kilogram of body weight and serum levels of fibrinogen, von Willebrand factor (vWF) activity, tissue type plasminogen activator activity, and plasminogen activator inhibitor activity were not sensitive to the administration of deamino-8-D-arginin vasopressin at any time interval during surgery or at 24 hours after surgery (P > 0.05). Only factor VIII:C levels exhibited significant elevations at 30 minutes and at 24 hours (P < 0.05). CONCLUSIONS: This study could not demonstrate any significant effect of deamino-8-D-arginin vasopressin on the amount of blood loss in a group of patients with idiopathic or congenital scoliosis. Findings indicate that for most of the coagulation factors, any changes in serum levels induced by deamino-8-D-arginin vasopressin were much like those expected from surgery itself. This study also failed to demonstrate any significant effects altering the urinary output that may be attributed to the use of deamino-8-D-arginin vasopressin.

Adolescent↗
PubMed1999

Luque trolley and convex epiphysiodesis in the management of infantile and juvenile idiopathic scoliosis.

STUDY DESIGN: Retrospective analysis of 5-year follow-up data from patients instrumented with Luque trolley with or without convex epiphysiodesis for management of progressive infantile and juvenile idiopathic scoliosis. OBJECTIVE: To assess results, establish predictors of outcome, and suggest more effective surgical interventions. SUMMARY OF BACKGROUND DATA: Initial results have been reported. There are no long-term follow-up studies. METHODS: Luque trolley instrumentation was used in eight patients with idiopathic scoliosis between 1983 and 1984. Luque trolley with convex epiphysiodesis was used in 18 patients between 1984 and 1990. RESULTS: Changes in Cobb angle from 8-week to 5-year follow-up are as follows. For Luque trolley alone, Cobb angle worsened for all patients. For progressive infantile scoliosis managed with Luque trolley and convex epiphysiodesis, Cobb angle worsened in seven, remained unchanged in four, and improved in two patients. Mean age at operation was 3.1 years (range, 1.5-7.4 years), and instrumented spinal growth was 32% of expected growth. Preoperation Cobb angle was 65 degrees (range, 40-95 degrees). Cobb angle at 5-year follow-up was 32 degrees (range, 0-86 degrees), which is predicted by preoperation apical concave rib-spinal angle (P = 0.002) and upper end vertebral tilt (P = 0.04). For juvenile idiopathic scoliosis managed with Luque trolley and convex epiphysiodesis, Cobb angle worsened in three patients and improved in one. CONCLUSIONS: Luque trolley instrumentation alone does not prevent curve progression. Additional convex epiphysiodesis results in curve resolution in some patients, which suggests a growth effect. Both spine and rib factors predict Cobb angle at 5-year follow-up.

Braces↗
PubMed1999

Variability of somatosensory-evoked potentials in different stages of scoliosis surgery.

STUDY DESIGN: A comparison of the latencies and amplitudes of the somatosensory-evoked potential in different stages of scoliosis surgery. OBJECTIVES: To investigate the normal variability of the somatosensory-evoked potential at different stages of scoliosis surgery and to improve the reliability of spinal cord monitoring. SUMMARY OF BACKGROUND DATA: False alarms in intra-operative spinal cord monitoring have been reported when the somatosensory-evoked potential measured before skin incision was used as the reference baseline value. However, the normal variability during different stages of surgery and the specificity of somatosensory-evoked potential is not well documented. METHODS: The somatosensory-evoked potential of 90 patients who underwent surgical correction for idiopathic scoliosis was monitored intraoperatively, with stimuli applied to the posterior tibial nerve. The amplitudes and latencies of the somatosensory-evoked potential were recorded over Cz'-Fz and Cv-Fz. The values of latencies and amplitudes and their percentage variabilities were analyzed. RESULTS: The values of latencies and their percentage variabilities did not differ significantly from each other in different stages of surgery. The values of amplitudes between different stages showed statistically significant differences. In particular, the amplitude of the somatosensory-evoked potential was found to be significantly decreased after exposure of the spine when compared with the amplitude before skin incision. CONCLUSION: Some variability in latencies and amplitudes between different stages of scoliosis surgery is normal. These results suggest that the somatosensory-evoked potential when the spine is exposed may be used as the reference baseline to determine whether somatosensory-evoked potentials are subnormal at the subsequent stages of surgery.

Adolescent↗
PubMed2000

Posterior spinal instrumentation and fusion of a neuromuscular scoliosis in a patient with autosomal dominant osteopetrosis.

STUDY DESIGN: A case report of a patient with autosomal dominant osteopetrosis and neuromuscular scoliosis who required surgical instrumentation and fusion of her spine. OBJECTIVE: To illustrate the surgical technique and long-term outcome in this rare form of spinal deformity. SUMMARY OF BACKGROUND DATA: Osteopetrosis is a group of rare skeletal dysplasias characterized clinically by skeletal osteosclerosis that is classically described in appearance as "marble bone." Despite the ubiquitous involvement of the vertebra, clinical manifestations of spinal involvement are uncommon. We present the case of an osteopetrotic patient with neuromuscular scoliosis who required surgical correction of her progressive deformity. There are no prior reports in the literature concerning operative or nonoperative management of scoliosis in this patient population. METHODS: The surgical technique utilized as well as the patient's response to surgical management of her scoliosis is presented with 5 year follow-up. RESULTS: The patient underwent a successful T4 to L1 posterior spine fusion and instrumentation using Luque rods, sublaminar wires and allograft bone augmentation. At 5 years following her index procedure, she is clinically and radiographically fused. CONCLUSION: Patients with osteopetrosis present unique surgical challenges during surgical correction of spinal deformities. The use of segmental sublaminar wires with 1/4-inch rods and crosslinks afforded stable fixation despite poor bone quality. Allograft bone combined with postoperative bracing resulted in a well-maintained correction and a solid fusion. Five year follow-up and continued radiographic evidence of stable fusion indicate that the presented approach can lead to a successful outcome in the osteopetrotic patient population.

Adult↗
PubMed2000

Vertebral decancellation for severe scoliosis.

STUDY DESIGN: The results of staged surgery including vertebral decancellation were reviewed retrospectively for 21 patients with severe scoliosis. OBJECTIVES: To evaluate the benefits and limitations of vertebral decancellation as new anterior surgical procedure. SUMMARY OF BACKGROUND DATA: The curvatures of severe scoliosis are often very rigid, and surgical correction using the anterior or posterior approach may not achieve the desired correction. Some studies reported neurologic complications might appear due to the aggressive approach or excessive correction force. METHODS: Twenty-one patients (average age, 17.0 years) with severe scoliosis, in whom Cobb angle was over 80 degrees (average angle, 107 degrees), underwent staged anterior and posterior spinal reconstruction. Vertebral decancellation was performed as anterior procedure, and until posterior instrumentation, halo traction was carried out. The transition of curvatures in coronal and sagittal planes was assessed in this series. RESULTS: The average correction rate of lateral curvature at the final follow-up was 46%. The average loss of correction was 2.5 degrees. Kyphosis, measured between T5 and T12, changed from 41 degrees to 36 degrees. Lordosis, measured between L1 and S1, changed from 56 degrees to 45 degrees. Transient neurologic deficit was seen in one case after vertebral decancellation. CONCLUSIONS: Staged surgery including vertebral decancellation is an effective surgical method for patients with severe scoliosis, where an inflexible rigid curve or the risk of occurrence of neurologic complications due to temporary correction may exist.

Adolescent↗
PubMed2000

The effect of continued posterior spinal growth on sagittal contour in patients treated by anterior instrumentation for idiopathic scoliosis.

STUDY DESIGN: Retrospective analysis of radiographs on a prospective cohort of patients undergoing anterior instrumentation for thoracic idiopathic scoliosis. OBJECTIVES: To analyze the change in sagittal profile after growth. SUMMARY OF BACKGROUND DATA: The authors previously reported some advantages of anterior instrumentation for treatment of thoracic idiopathic scoliosis. However, postsurgery hyperkyphosis has resulted in some patients, especially those who were skeletally immature at the time of surgery. METHODS: Inclusion criteria required that participants have thoracic idiopathic scoliosis treated with anterior instrumentation and a confirmed solid fusion, no rod breakage, and a minimum follow-up period of 2 years. The 47 patients meeting the criteria were divided into a study group of 10 patients who were Risser 0 at the time of surgery and a control group of 37 patients who were Risser 1 to 5. Progressive sagittal kyphosis was defined as an increase of 10 degrees or more (T5-T12) after surgery. RESULTS: Sagittal progression greater than 10 degrees (average, 15 degrees ) occurred in 6 of 10 patients (60%) in the study group (Risser 0). Five patients progressed from 10 degrees to 19 degrees, and one patient from 20 degrees to 30 degrees. In contrast, sagittal progression occurred in only 10 of 37 patients (27%) in the control group (Risser 1 to 5). CONCLUSIONS: Some patients with thoracic adolescent idiopathic scoliosis treated with anterior instrumentation may be at risk for progressive sagittal kyphosis secondary to growth. Skeletal immaturity (Risser 0) appears to be a risk factor. In these immature patients, preserving the sagittal profile with intervertebral spacers, rigid rods, and bone graft (allowing for an average 15 degrees increase of kyphosis with growth) may be appropriate.

Adolescent↗
PubMed2000

Torsional rigidity of scoliosis constructs.

STUDY DESIGN: A biomechanical study of the rigidity of various scoliosis constructs instrumented with and without caudal pedicle screw anchors and with none, one, or two cross-link devices. OBJECTIVES: To determine whether the increased torsional rigidity provided by distal pedicle screw fixation might make cross-linking unnecessary. SUMMARY OF BACKGROUND DATA: Pedicle screws and cross-linking devices have been shown to increase the structural rigidity of spinal constructs. Their relative contributions to scoliosis construct rigidity has not been determined. METHODS: "Short" (T2-T11) and "long" (T2-L3) scoliosis constructs were mounted on an industrially fabricated spine model and tested in a hydraulic testing machine. Four different short and four different long constructs were tested: hooks only, hooks with concave side thoracic sublaminar wires, hooks with distal pedicle screw anchors, and hooks, distal pedicle screw anchors, and concave thoracic sublaminar wires. There were four iterations for each construct tested: no cross-links, one superior cross-link at T4-T5, one inferior cross-link at T9-T10, and two cross-links. Torsional rigidity was tested by applying a rotational torque at T2. Vertebral body motion was recorded with a three-dimensional video analysis system. RESULTS: Constructs with distal pedicle screws were statistically more rigid in torsion than those with hooks as distal anchors. The additional torsional rigidity from one or more cross-links was negligible compared with that provided by pedicle screws. CONCLUSIONS: With pedicle screws as distal anchors in scoliosis constructs, cross-linking with one or two devices adds very little additional rotational stiffness and may be unnecessary in many cases.

Bone Screws↗