Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0003090 (arthrodesis)
 8,374 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Between 1968 and 1973 forty nine patients suffering from poliomyelitic scoliosis were treated surgically at the Rizzoli Institute. They were due to asymmetrical paralysis and contracture in the muscles of the trunk and limbs. Associated pathological conditions were found, such as pelvic obliquity, and vascular and trophic changes due to ganglionic lesions. The differing incidence and combination of these factors gave rise to various clinical types of spinal deformity. The average severity of curve was 39 degrees, the localisation was predominantly central, the average extent was ten vertebrae, and there was a marked predominance of right convexity (twenty nine out of thirty six). The rate of progression was maximum during puberty and almost negligible after bony maturity. It was greater in males and was unfavourably affected by the severity and asymmetrical distribution of the paralysis, by the early appearance of the disease, by high localisation of the deformity, and by the erect posture in patients who were ambulant. The most frequent visceral complications were in the respiratory system (ten patients with a deficit over 50%), followed by cardiac changes. Surgical treatment was adopted in patients with progressive curves over 60 degrees, because of the inevitable deterioration in their general condition and the tendency of the deformity to become fixed. Pre-operative correction by Halo-traction results (52% correction) than Risser plasters (38%). Posterior arthrodesis by Harrington's method was carried out in all the more recent cases (forty four). Post-operative plaster was maintained for eight months and then replaced by an orthopaedic corset. At bony maturity there was an averaged improvement of 35% in the angle of curvature, and an average improvement of 6% in vital capacity. The best corrections were obtained in patients under fourteen (42%), in dorso-lumbar scoliosis (40%) and in patients with curves above 100 degrees (38%). There was an average increase in height of 9.1 cms and a reduction in the gibbus of 3.4 cms. The complications included one traumatic pneumothorax, eight pseudarthroses, and breakage of the distraction rod in two cases resulting in complete relapse of the deformity. In six cases the upper hooks became loos and there were two cases of postoperative staphylococcal infection. In the distally sited curves our present policy is towards combining posterior arthrodesis with Dwyer's anterior interbody fusion.
 ...
PMID:Surgical treatment of poliomyelitic scoliosis. 102 7

The authors carried out a study of respiratory function in seventy six patients suffering from severe scoliosis of different types; forty five idiopathic, sixteen poliemyelitic, ten congenital, and five neurofibromatosic. The age incidence was from a minimum of eleven years to a maximum of thirty three, with the average around fifteen years. The site of the deformity was predominantly dorsal (fifty cases), though there were also lumbar and dorso-lumbar types. The average angle of curvature (Cobb) before treatment was 110 degrees. Arthrodesis by the Harrington technique was carried out on all patients after correction with a Risser-type plaster in sixty nine cases, and Halo-traction in seven cases. The post operative period in plaster was about eight months. Spirometric tests were carried out before treatment, after preoperative correction, and two to three years after operation, always with the chest out of plaster. The results of these tests are expressed as percentage reductions in the maximum ventilation compared with the average normal values in the tables reported by Baldwin et al. (1948). The values obtained before commencing treatment showed that lumbar scoliosis even if very severe, never leads to severe respiratory deficits. There is no linear relationship between the severity of the curve and the respiratory deficit, though there is a general connection between them. Tests of respiratory function were carried out after corrective treatment, both before and after operation and at a two year follow up. There was an overall average improvement of 10% in the respiratory deficit, with a maximum of about 20% in a group of twenty two patients with the most severe deficit before commencing treatment. Follow-up three years after operation showed the improvement in respiratory fimction had been maintained. The authors conclude that arthrodesis by the Harrington technique does not diminish the respiratory gain achieved by pre-operative correction. On the contrary, it stabilises it and maintains it over the three year follow-up period of the present survey.
 ...
PMID:Respiratory function in severe scoliosis before and after treatment (a review of 76 cases). 102 11

Two cases of atlanto-axial rotatory dislocation following ear and head surgery are presented. Reduction was followed by Halo bandage in one, and by wedge C1-2 arthrodesis and Halo bandage in the other. The importance of early recognition by diagnostic CT-scan is emphasized.
 ...
PMID:[Rotatory atlanto-axial luxation in children]. 278 45

Atlantoaxial instability in rheumatoid arthritis has been recognized in the natural history of rheumatoid arthritis, but successful surgical stabilization has proven to be elusive. We review our experience using the Brooks technique of wedge compression arthrodesis combined with halo immobilization in five women with rheumatoid arthritis with symptomatic C1-2 subluxation. Halo-vest immobilization was continued for six weeks postoperatively, and then exchanged for a rigid cervical orthosis for an additional six weeks. Solid, asymptomatic fusion developed in all patients within this 12-week period. Follow-up ranges from 18 to 56 months. One major complication occurred in a patient who had significant postoperative quadriparesis in spite of normal intraoperative sensory evoked potentials; it has since slowly resolved.
 ...
PMID:Brooks fusion for atlantoaxial instability in rheumatoid arthritis. 335 71

This paper described 27 patients who had seemingly stable compression cervical vertebral fractures. All were treated in cervicothoracic orthoses. None was initially treated in a Halo device or with surgery. Twenty patients were stable and healed without progressive displacement, angulation, or pain. One patient demonstrated an angular deformity, which spontaneously stabilized within six months with anterior bony ankylosis in a kyphotic position. Six patients demonstrated persistent progressive post-injury instability related to posterior ligament rupture. As muscle spasm diminished, the patients could be given a more reliable flexion-extension radiographic examination, unmasking the hidden posterior instability. Five of the six who demonstrated this instability were disabled because of pain. Two of the six patients were treated with a two-segment fusion. The other four have had fusion recommended and are currently being followed clinically. This paper emphasizes the need for better initial criteria of potential instability and close follow-up of patients with simple compression fractures of the cervical spine.
 ...
PMID:Unrecognized spinal instability associated with seemingly "simple" cervical compression fractures. 666 70

Although posterior plates are increasingly used to manage cervical spinal instability, long-term follow-up evaluation of patients with a critical analysis of efficacy and complications has not been reported. The authors have retrospectively analyzed the outcome in 44 consecutive patients (37 males and seven females, age range 16 to 80 years) treated with posterior cervical plates. The indications for instrumentation were instability due to trauma in 42 cases, tumor in one, and infection in one. In four patients the follow-up period was limited to 3, 5, 11, and 16 months. Two patients died of chronic medical problems 4 and 9 months after treatment. The remaining 38 patients were followed from 2 to 6 years (mean 46 months). One motion segment was stabilized in 23 patients using two-hole plates; two motion segments were stabilized in the other 21 patients using three-hole plates. In the majority of patients (37 cases), supplemental bone grafting was not used. Patients were immobilized postoperatively in a Philadelphia collar. Solid arthrodesis was achieved in 39 (93%) of 42 patients. Three patients required revision of the cervical plating: in one patient with a C-5 burst fracture, two-hole plates were applied at C5-6 and progressive kyphosis mandated anterior fusion; the second patient required posterior wiring due to screw pull-out resulting from a technical error in screw insertion; the third patient, who refused to wear an orthosis postoperatively, also developed screw pull-out. In two patients who went on to spinal fusion, there was an increase in sagittal kyphosis (6 degrees and 8 degrees) without clinical sequelae. Screw loosening was noted in five patients, involving eight (3.8%) of the 210 lateral mass screws; this complication resulted in instrumentation failure or increased kyphosis in three cases. There were two superficial infections. This analysis indicates that posterior cervical plating is highly effective; at long-term follow-up review the cervical spine was successfully stabilized in 93% of cases. Plate failure was related to faulty screw placement, failure to include sufficient motion segments, and noncompliance with postoperative orthoses. Halo vest immobilization was unnecessary and supplemental bone grafting was generally not required for recent trauma.
 ...
PMID:Posterior plates in the management of cervical instability: long-term results in 44 patients. 805 40

C1 partial aplasia is a rare congenital deformity which can produce unacceptable progressive severe torticollis. Five such cases treated in two regional Pediatric Hospitals of Argentin are presented here. There were 4 girls and 1 boy, with a mean age of 6 years; four of them had formation defect of articular mass (Villa's Area 3) causing fixed torticollis in 3 who underwent surgery. In another case the defect consisted of a posterior hemi-arch (Area 2). Surgical procedures consisted on isolated posterior occipito-cervical arthrodesis in two cases, and associated with a posterior decompression by suboccipital craneotomy in the third, due to the presence of preoperative neurological deficit. Some internal fixation was achieved with sutures (non reabsorbibles in younger patient and wire suture in older ones). Average postoperative immobilisation with Halo-vest was 4.5 months, and it was followed with extended Philadelphia collar until complete consolidation. Non-operated patients responded to conservative therapy. Mean followup was 1 year 8 months. All patients presented correction of the deformity. The 3 surgically treated patients showed good arthrodesis and disappearance of preoperative delicit when present. In conclusion, the unilateral hipoplasias of C1 in children with unyielding deformity can be satisfactorily managed by means of CO-C2/C3 arthrodesis with or without decompression, always associated to external immobilization.
 ...
PMID:[Hemi-atlas: report of five cases]. 1287 71

Although halo fixation in children aged 3 years or younger is described, no study has reported results in this age group. A retrospective review was conducted among children aged 3 years and younger and treated with halo ring fixation. Thirteen patients were identified, with an average age of 26 months (range, 16-43 months) at halo application. Six patients were treated for trauma, 6 for stabilization after cervical arthrodesis, and 1 for traction for progressive infantile scoliosis. All the children required custom or modified rings and vests. On average, 8 pins (range, 6-12) were used for fixation with torque from 2 to 4 in-lbs. Nine (69%) of the 13 patients had complications including 6 pin infections, 3 falls, and 1 respiratory difficulty. Only 1 child required further surgery. None developed posttreatment skull deformity. Halo ring fixation is safe in children aged 3 years and younger and has a complication rate similar to that in older children. Pin problems can be treated effectively by standard means. Unique to this age group, toddlers may be more prone to falls than older children, and limited ambulation should be recommended.
 ...
PMID:Complications and problems in halo treatment of toddlers: limited ambulation is recommended. 1706 39

We review the management of cervical spinal lesions in rheumatoid arthritis. Surgical treatment for cervical lesions presents several potential problems, such as spinal cord injury during surgery, prolonged and painful postoperative immobilization, poor outcome incompatible with surgical invasiveness, and a high failure rate of arthrodesis. The introduction of spinal instrumentation techniques to surgery for cervical lesions has solved some of these problems. Rigid spinal fixation using screws, rods, and wires has made surgery more reliable, and has freed patients from painful postoperative immobilization methods such as the Halo vest. However, the effects of surgical treatment have not been clearly examined using methods of evidence-based medicine. There is a need for clinical studies of treatment for cervical lesions, in order to help establish better methods for the management of cervical spinal lesions.
 ...
PMID:Management of cervical spinal lesions in rheumatoid arthritis. 1714 59