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PubMed2005

Neuromuscular scoliosis treated by segmental third-generation instrumented spinal fusion.

We aimed to investigate whether the outcome and complications of surgical treatment of neuromuscular curves with segmental third-generation instrumentation could compare with those reported with standard second-generation instrumentation. The clinical and radiologic data of a single surgeon's consecutive series of patients with neuromuscular scoliosis treated with two types of newer-generation instrumentation and posterior or anteroposterior approaches were retrospectively and independently reviewed. The results of this study support the concept that third-generation instrumentation is able to provide at least as good results as second-generation instrumentation in the treatment of neuromuscular scoliosis patients, at the expense of a lower complication rate.

Adolescent↗
PubMed2006

A large adolescent idiopathic scoliosis curve in a skeletally immature patient: is early surgery the correct approach? Overview of available evidence.

The goal of this study was to determine whether the available studies provide enough evidence that, in a borderline case of adolescent idiopathic scoliosis with a large (35 to 50 degrees) curve in a skeletally immature patient (Risser 0 to 2) with significant growth potential left, a conservative line of management in the form of bracing can be considered, rather than to rush into a potentially unnecessary major spinal surgery. We reviewed the literature spanning the last 20 years for the results of bracing in this specific group of patients. From the 9 studies selected, a group-specific data extraction was carried out. Three hundred and five patients with a 36 to 50 degrees scoliosis curve and Risser stages 0 to 2 were treated by bracing and the treatment was termed successful in 160 patients. Thus, more than half (52.5%) of the patients were successfully managed with a brace and were spared surgery. The current trend for management of these curves is early surgical intervention, the rationale being the ineffectiveness of bracing in preventing the progression of such a large curve and the difficulty in obtaining satisfactory correction by postponing surgery to a later date. On the basis of our results, we propose a conservative line of management for these curves, in contrast with current views, rather than to rush into a major spine surgery, expecting a favorable outcome with a well-supervised bracing program. If the curve progresses, surgery can always be considered later, keeping in mind the excellent correction obtained with the pedicle screw systems even for large curves of 70 to 100 degrees.

Adolescent↗
PubMed2004

Treatment of massive thoracolumbar wounds and vertebral osteomyelitis following scoliosis surgery.

Closure of thoracolumbar wounds and vertebral osteomyelitis after scoliosis surgery often proves difficult due to tautness and lack of usable tissue, and the resulting dead space containing metallic fixation devices is predisposed to infections and complications. The authors present their experience with 33 patients in whom massive thoracolumbar wounds and vertebral osteomyelitis developed following scoliosis surgery. Postoperative infection, due to the lack of vascularized tissue and presence of metallic hardware near the wound, is common and extremely counterproductive; within these cavernous wounds lie infected vertebrae, metallic hardware, and bone graft. The use of a modified and extended latissimus dorsi myocutaneous flap to close and supply blood to wounds in the lower thoracic and thoracolumbar areas is described. This surgical approach, predicated on effective débridement along with reconstruction by transposition of vascularized tissue, allows the wound to close and drastically decreases the risk of postoperative infection. Furthermore, for wounds already infected, the procedure allows for closure and increased blood supply to the area, thus giving the wound a much greater ability to heal. For wounds involving the lumbosacral area, the authors combine this with a transposed gluteus maximus muscle flap to obtain coverage over the caudal extent of the wound. In this study, all flaps accomplished their intended purpose: to secure the healing of once-infected wounds and to allow preservation of orthopedic instrumentation and bone graft. Follow-up revealed no flap losses, pseudarthroses, or loss of orthopedic instrumentation in the study group.

Adolescent↗
PubMed1998

A modified Harrington technique for scoliosis.

Post-Harrington techniques for adolescent idiopathic scoliosis have increased the complexity of scoliosis surgery while contributing only biomechanically more secure fixation and sagittal contour preservation. On the the basis of principles defined by Harrington, the authors developed a simplified technique that accomplishes equivalent outcomes.

Biomechanical Phenomena↗
PubMed1998

Solid rod short segment anterior fusion in thoracolumbar scoliosis.

Seventeen patients with adolescent idiopathic thoracolumbar scoliosis underwent short segment anterior spinal fusion with a solid rod-screw construct. Patients were evaluated radiographically and interviewed using the Scoliosis Research Society instrument. Mean radiographic follow-up was 34 months, and mean follow-up at time of interview was 62 months. Mean curve correction was 87%, declining to 67% at 2 years. Mean correction of the instrumented curve was 114%, declining to 103% at 2 years. The thoracic curve improved 24% and remained stable throughout the follow-up period. Kyphosis over the instrumented segments increased from 4 degrees preoperatively to 10 degrees postoperatively. Although there was a trend toward increasing kyphosis over time, this was not statistically significant at final follow-up. Most patients (88%) were extremely satisfied with the surgical result. We believe that a short-segment anterior fusion with a solid rod-screw construct provides excellent curve correction with minimal kyphosis over the instrumented segment. Overcorrection of the instrumented segment must be achieved for this technique to be successful.

Adolescent↗
PubMed1998

The effectiveness of preoperative erythropoietin in averting allogenic blood transfusion among children undergoing scoliosis surgery.

Concerns about the transmission of the human immunodeficiency virus (HIV) have driven the evolution of surgical transfusion practices including the use of preoperative erythropoietin (rhEPO). Although there is significant experience documenting the efficacy of preoperative rhEPO in reducing transfusion requirements for adult patients, there is little experience in the pediatric population. With 178 pediatric patients who underwent surgery for spinal deformity, a retrospective cohort study was performed using patient charts, administrative records, and blood bank computer data. Of these patients, 44% received erythropoietin and 55% did not. From the entire population, 17.5% were in the rhEPO treatment group that received homologous blood transfusion compared with 30.6% in the untreated group (p < 0.05). Among the children with idiopathic scoliosis, this effect was more pronounced, with 3.9% of rhEPO patients receiving blood transfusion compared with 23.5% of nontreated patients (p = 0.006). Additionally, rhEPO treatment was associated with a significantly decreased length of stay only for patients in the idiopathic group (9.3 vs. 6.7, p = 0.02). Use of preoperative erythropoietin in pediatric patients undergoing scoliosis surgery resulted in higher preoperative hematocrit levels. Significantly lower rates of transfusion were noted only in the idiopathic group, however. Although there is a possibility of erythropoietin "resistance" in the neuromuscular and congenital patients, alternative explanations for the lack of effect on transfusion rates may include underdosing and biases existent in this nonrandomized retrospective study.

Adolescent↗
PubMed1984

Incidence, natural history, and treatment of scoliosis in Friedreich's ataxia.

We carried out a retrospective study of 42 patients with documented Friedreich's ataxia to answer four questions: what is the incidence and natural history of scoliosis in Friedreich's ataxia, and what are the results of operative and nonoperative treatment? We concluded that the incidence of scoliosis in true Friedreich's ataxia is extremely high. The curves tend to progress with the severity of the disease and often tend to progress after skeletal maturity. Bracing and electrospinal instrumentation have no role in treatment. Patients with progressive curves should have early surgical stabilization.

Adolescent↗
PubMedDate not supplied

An evaluation of muscle pathology in idiopathic scoliosis.

This study assessed the degree of longissimus muscle pathology in 15 patients with idiopathic scoliosis. Bilateral muscle biopsy specimens were taken at the apex of the scoliotic curve and from five control subjects and processed histochemically. All biopsy specimens were free of muscle pathology. However, patients had a higher proportion of Type I fibers on the convex than the concave side of the curve (70.2 vs. 59.5%), whereas the controls had no difference. Fiber type imbalance in patients with idiopathic scoliosis is thought to result from compensatory stretching of muscle and not to be the cause of the deformity.

Adolescent↗
PubMedDate not supplied

Effect of a thoracolumbosacral orthosis on lateral trunk shift in idiopathic scoliosis.

The effect of the Wilmington brace on lateral trunk shift in adolescent idiopathic scoliosis was studied in 80 patients. With an average follow-up of 1 year 10 months after completion of brace treatment, improvement was seen in 58% of those patients with thoracic curves, 65% with thoracolumbar-lumbar curves, and 88% with double major curves. Lateral trunk shift decreased an average of 0.8 cm in patients with thoracic curves and 1.0 cm in patients with thoracolumbar-lumbar or double major curves. Improvement of existing lateral trunk shift was an additional consideration for instituting brace treatment in idiopathic scoliosis.

Adolescent↗
PubMedDate not supplied

Is lateral electric surface stimulation an effective treatment for scoliosis?

Eighteen patients with scoliosis were treated with lateral electric surface stimulation (LESS). Four (23%) discontinued the program because of discomfort, five did not carry through an adequate treatment program, and nine (50%) coped with a proper program. In spite of a good initial correction, five patients in the latter group progressed during treatment. Muscle biopsy specimens before and after a treatment period of 18 months revealed a tendency for the stimulation output to spill over to the concave side of the curve. In this study, LESS has not been an effective treatment for scoliosis.

Biopsy↗
PubMedDate not supplied

Pathology and morphometry of the paraspinous muscles in nonidiopathic scoliosis.

The muscle fibers in 19 patients with nonidiopathic scoliosis were generally small, especially on the concave side of the curve. Type 1 fibers were more frequently atrophic than type 2 fibers, but the former usually remained larger than the latter. Type 1 preponderance was greater on the convex side of the curve; type 2A preponderance occurred bilaterally. These changes are similar to those of idiopathic scoliosis. They resemble those of endurance training or stretch and are interpreted as secondary to the curve.

Adolescent↗
PubMedDate not supplied

Scoliosis associated with Duchenne muscular dystrophy.

The pathoanatomy and natural history of scoliosis associated with Duchenne muscular dystrophy were established by a review of 105 patients. Scoliosis developed in 95% of these patients after the loss of ambulation. The direction of the curve was determined by asymmetrical contracture of the iliotibial band. Functional classification using the radiographic sitting kyphotic index proved a reliable guide to the age at loss of ambulation and life expectancy, as well as the rate of progression and eventual severity of spinal deformities. Spinal orthoses failed to control curve progression in 94% of patients (30 of 32). Fourteen patients underwent spinal fusion with excellent long-term results.

Adolescent↗
PubMedDate not supplied

Congenital scoliosis and urinary tract abnormalities: are intravenous pyelograms necessary?

One hundred patients with a diagnosis of congenital scoliosis were reviewed with regard to their urologic history, chemistries, and excretory urography. A 40% incidence of urologic abnormality was found in these asymptomatic patients. Twenty-five additional patients were evaluated by excretory urography and ultrasonography. Of six patients identified by ultrasonography as having abnormalities five had results confirmed by excretory urography. Urologic evaluation of all patients with congenital scoliosis is recommended; however, diagnostic ultrasonographic evaluations of the urinary tract have proven to be an acceptable alternative as an initial screening modality.

Female↗
PubMedDate not supplied

Scoliosis secondary to osteoblastoma of the rib.

An 8-year-old girl with a progressive, painless spinal deformity is presented. She was found to have an atypical scoliosis secondary to a stage 3 benign osteoblastoma of the rib. This case is presented to emphasize that atypical scoliosis in skeletally immature individuals requires a thorough investigation for an underlying cause.

Bone Neoplasms↗
PubMedDate not supplied

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↗
PubMedDate not supplied

Biological factors and predictability of bracing in adolescent idiopathic scoliosis.

Biological factors that could have a predictive value in treating idiopathic scoliosis by brace were studied in 107 patients (102 girls and 5 boys). The mean age of the patients was 14 years 6 months, and the mean Cobb angle of the curves was 36 degrees at start of treatment. The Boston brace was used for an average of 1 year 6 months, and mean follow-up time after weaning was 3 years. Scoliosis with an apex of Th 10-12 proved to be the most favorable for the final result, with a mean correction of 2 degrees. All other curves remained unchanged. Patients who had a period of rapid growth just before or during treatment had a better final result than the others. The final result was also better when treatment was started before menarche.

Adolescent↗
PubMedDate not supplied

Effect of scoliosis surgery on pulmonary function in patients with myelomeningocele.

Thirteen patients with myelomeningocele who required operation for scoliosis were tested for changes in pulmonary function 1 month before and an average of 13 months after spinal stabilization. The average age at the time of operation was 12 years 11 months. Ten patients had restrictive changes in pulmonary function preoperatively. Owing to the severity of scoliosis, an anterior approach to the spine including resection of ribs and division of the diaphragm was necessary for eight children. Postoperatively, despite these procedures, eight patients had an increase in vital capacity and six patients had an increased forced expiratory volume in 1 s.

Adolescent↗
PubMedDate not supplied

Crankshaft phenomenon in congenital scoliosis: a preliminary report.

To determine whether or not the crankshaft phenomenon occurs after spinal fusion in patients with congenital scoliosis, we reviewed 23 curves in 21 patients who were operated on before age 10 years. Operative procedures consisted of various kinds of posterior fusions as well as anterior and posterior hemiepiphyseodeses. Seven of the 23 curves progressed greater than or equal to 10 degrees during the course of follow-up, and six of the seven demonstrated increased rotation and were believed to demonstrate the crankshaft phenomenon. No spines rotated without curve progression. The only statistically predictive factor was length of follow-up. No curve that underwent anterior and posterior hemiepiphyseodeses demonstrated the crankshaft phenomenon. Although the crankshaft phenomenon can occur in young patients operatively treated for congenital scoliosis, apparently it can be prevented by anterior fusion.

Bone Diseases, Developmental↗