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Query: UMLS:C0003090 (arthrodesis)
 8,374 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Scoliosis is a complication of spinal lesions in neurofibromatosis, and leads frequently to major deformities with dislocations. The authors conducted a critical study of 31 cases surgically treated during the 1954-73 period of time. The techniques of spine straightening and of arthrodesis were recalled. The authors conclude that in case of moderate deformity (less than 100 degrees) Harrington's operation was satisfactory enough when correctly conducted. In case of severe dislocation and kyphosis, straightening was obtained after long lasting casts and halo tractions. Then posterior fusion using Harrington's rods had usually to be completed by anterior, transthoracic fusion for better solidity.
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PMID:[Critical evaluation of the surgical treatment of vertebral lesions due to neurofibromatosis. 31 cases (1954-1973)]. 12 68

Cotrel-Dubousset (CD) instrumentation has been employed in 12 patients with neurofibromatosis with spinal deformity (ten regular scoliosis, one dysplastic kyphoscoliosis, and one multilevel laminectomy). The follow-up period averaged 33 months. In regular scoliosis frontal correction averaged 69%, axial derotation averaged 33%, and sagittal normalcy was produced without immobilization and without pseudoarthrosis. Successful arthrodesis was obtained in a dysplastic patient after initial failure via anterior concave struts and posterior CD instrumentation with immobilization. Stabilization and fusion of one patient with multiple-level thoracic laminectomy was achieved without immobilization. CD instrumentation is effective in the surgical management of neurofibromatous spinal abnormalities.
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PMID:Cotrel-Dubousset instrumentation in neurofibromatosis spinal problems. 250 43

A study of 116 patients younger than 12 years of age conclusively diagnosed as having neurofibromatosis was undertaken to determine the incidence of significant orthopedic problems. Deformities of the spine comprised the most common skeletal problem. Seventy-four patients (64%) had spinal deformities. Forty-six patients were treated by posterior spinal fusion. Ten required exploration for pseudarthrosis; six were found to have pseudarthrotic defects in the fusion mass. Eight patients had more kyphosis than scoliosis. Only three patients with kyphoscoliosis obtained a solid posterior spinal fusion after multiple surgical procedures. Anteroposterior and lateral roentgenograms of the cervical spine are recommended at the time of initial evaluation of all spinal deformities. Four patients had severe cervical spine deformities, only one of whom was initially identified as having a cervical spine disorder while under treatment for scoliosis. Three of these patients were seen by other surgical services for neck masses. Following removal of posterior elements, the osseous structures were unstable. Only one patient developed spondylolisthesis. Because of the exceedingly high incidence of pseudarthrosis and spinal instability following attempts at spinal fusion, certain guidelines have evolved for the management of these deformities. High-volume computed tomographic myelography in the prone, lateral, and supine positions or magnetic resonance imaging should be performed on all patients prior to surgical treatment. Anterior disc excision and bone graft followed by posterior arthrodesis with instrumentation are indicated if the kyphotic angle is greater than 50 degrees or if scoliosis is greater than 80 degrees. Even combined anterior and posterior arthrodesis operations did not guarantee successful permanent spinal stability in young patients with neurofibromatosis.
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PMID:Pitfalls of spinal deformities associated with neurofibromatosis in children. 250 47

Digital gigantism is an unusual congenital anomaly that is present at birth or recognized in early infancy and is progressive during the period of normal skeletal maturation. It involves cell types that are predominately affected by neurogenic growth control and follow a distribution similar to the sensory supply of a major peripheral nerve, usually the median nerve. There seem to be three variants that overlap somewhat in clinical presentation. They are type I digital gigantism with lipofibromatous hamartoma of a peripheral nerve, type II digital gigantism associated with neurofibromatosis, and type III hyperostotic digital gigantism. Treatment should be individualized and initiated early in life. Epiphysiodeses, osteotomies, and division of branches of the supplying digital nerves may be indicated during childhood. In the adult, arthrodesis of the interphalangeal joints with bony shortening or ray resection may be indicated. Skin flap necrosis is a common complication postoperatively.
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PMID:Macrodactyly. 393 54

Vertebral deformity in neurofibromatosis can present in two basic forms which determine the prognosis and treatment. In the first form, which is rare, there are no gross dystrophic changes, while in the second, which is the more common, such changes are widespread. Neurofibromatosic scoliosis where there are no signs of bone dystrophy poses no particular therapeutic problems. However, the surgical treatment of the dystrophic form is much more complex and the results far more uncertain. There is a high incidence of pseudarthrosis following posterior arthrodesis and fixation with Harrington rods, and this has shown the need for combined posterior and anterior arthrodesis in all cases of neurofibromatosic kyphoscoliosis. Furthermore, posterior arthrodesis alone does not provide protection against future relapse even when kyphosis is initially absent. Delayed kyphosis, due to subsidence of the vertebral bodies, frequently appears after six months and necessitates a second operation to reinforce the posterior arthrodesis. However, a greater guarantee of stability can be achieved simply by performing combined anterior and posterior arthrodesis at the outset.
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PMID:Surgical treatment of vertebral deformities in neurofibromatosis. 641 55

A new wiring technique for occipitocervical arthrodesis was used in sixteen consecutive children between 1985 and 1992. The twelve boys and four girls had an average age of nine years and six months (range, two years and five months to nineteen years and three months) at the operation. The arthrodesis was performed between the occiput and the second cervical vertebra in ten patients and between the occiput and the third cervical vertebra in six. The instability was related to congenital anomalies (six patients), decompression for cervical stenosis (four patients), Down syndrome (three patients), trauma (one patient), resection of a tumor (one patient), and neurofibromatosis (one patient). Six patients needed a laminectomy for decompression because of cervical stenosis or for removal of a tumor. All of the patients were managed with an autogenous bone graft from the iliac crest and postoperative immobilization with a halo device. Fusion was achieved in fifteen of the sixteen patients. Complications developed in seven patients. The use of wire fixation, combined with the inherent stability of the bone-graft construct, allowed for removal of the halo device relatively early (range, six to twelve weeks), before the fusion was fully mature. No graft was displaced. All of the patients were followed at least until there was radiographic evidence of fusion (fifteen patients) or until a reoperation was performed (one patient). The average duration of follow-up was thirty-seven months (range, twelve to 108 months).
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PMID:Occipitocervical arthrodesis in children. A new technique and analysis of results. 764 70

When evaluating patients with neurofibromatosis and scoliosis, a careful search for the evidence of dystrophic changes should done, because prognosis and management depend highly on the presence of these changes. Preoperative imaging studies including computed tomography or magnetic resonance imaging are recommended, especially in cases of dystrophic scoliosis, to detect unrecognized intraspinal lesions. The radiographic findings and the response to treatment in patients with nondystrophic scoliosis are similar to those in patients with idiopathic scoliosis, and the same decision-making process for idiopathic scoliosis is applicable. Careful follow-up evaluation is mandatory, however, because of the tendency for extraordinary progression to occur with growth. Brace treatment of the short, angulated, dystrophic curves is ineffective; early and aggressive surgical intervention is strongly recommended. In most cases, dystrophic curvatures are best treated with combined anterior and posterior spinal arthrodesis. The fusion area should be generous, and the entire structural area of the deformity both anteriorly and posteriorly should be fused.
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PMID:Spine update. The management of scoliosis in neurofibromatosis. 943 13

Mandibular deformities and malformations are quite various. They are mostly identified by clinical examination, but imaging is very useful for surgical planning. CT imaging is essential to evaluate patients with dystrophies such as fibrous dysplasia, neurofibromatosis, Gorlin syndrome and cherubism. Some growth abnormalities lead to a pseudomalformative appearance. Sequelae and ankylosis from condylar fracture, and unilateral mandibular hypoplasia due to capillary-venous malformation require CT or/and MR evaluation. CT with 3D reformations is performed as a complement to clinical evaluation in patients with other growth abnormalities such as orthognathic problems, hypercondylia, and some malformations like lateral facial clefts. MR is helpful for soft tissue evaluation in patients with Parry-Romberg syndrome and Pierre Robin dysostosis.
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PMID:[Imaging of mandibular malformations and deformities]. 1367 50

Spinal deformity is the commonest orthopaedic manifestation in neurofibromatosis type-1 and is categorized into dystrophic and non-dystrophic types. Management should be based on a meticulous assessment of the spine with plain radiography and magnetic resonance imaging (MRI) to rule out the presence of dysplastic features that will determine prognosis and surgical planning. MRI of the whole spine should also be routinely obtained to reveal undetected intraspinal lesions that could threaten scheduled surgical interventions. Non-dystrophic curvatures can be treated with similar decision-making criteria to those applied in the management of idiopathic scoliosis. However, close observation is necessary due to the possibility of modulation with further growth and due to the increased reported risk of pseudarthrosis after spinal fusion. The relentless progressive nature of dystrophic curves necessitates aggressive operative treatment, which often has a significant toll on the quality of life of affected patients through their early childhood. Bracing of dystrophic curves has been unsuccessful. Combined anterior/posterior spinal arthrodesis including the entire structural component of the deformity is indicated in most cases, particularly in the presence of associated sagittal imbalance. This should be performed using abundant autologous bone graft and segmental posterior instrumentation to minimize the risk of non-union and recurrence of the deformity.
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PMID:Spinal deformity in neurofibromatosis type-1: diagnosis and treatment. 1571 1

Video-assisted thoracoscopic surgery is an alternative to open thoracotomy. We analyzed our experience during a consecutive series of 100 patients who had this procedure and who were available for study at 3-year followup. Video-assisted thoracoscopic surgery was done on patients with the following diagnoses: idiopathic scoliosis (n = 49), neuromuscular spinal deformity (n = 15), Scheuermann kyphosis (n = 15), congenital and infantile scoliosis (n = 5), neurofibromatosis (n = 5), Marfan (n = 1), postradiation scoliosis (n = 1), and repair of pseudoarthrosis (n = 1). Four patients had excision of the first rib to treat thoracic outlet syndrome. One patient had excision of an intrathoracic neurofibroma and one a benign rib tumor. One had anterior arthrodesis after fracture-dislocation of the thoracic spine and another had anterior fusion for vertebral osteomyelitis. The average operative time for the thoracoscopic anterior release with discectomy and arthrodesis was 253 minutes. The average number of discs excised was 8. Final postoperative scoliosis and kyphosis corrections were 68% and 90%, respectively. Complications related to thoracoscopy occurred in eight patients. Video-assisted thoracoscopic surgery provides a safe and effective alternative to open thoracotomy in the treatment of thoracic pediatric spinal deformities.
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PMID:Video-assisted thoracoscopic surgery: the Cincinnati experience. 1586 33


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