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Query: UMLS:C0700208 (scoliosis)
 8,574 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The authors review their experience in the management of 22 patients with hydromyelia over a 26-month period. Ten children had Chiari I malformations and hydromyelia; 4 children had myelomeningoceles (3 with large thoracic spinal cord cavitations and 1 with cervical hydromyelia); 6 children had distal hydromyelia associated with tethered cords and occult dysraphism; and 2 patients had cavitation subsequent to arachnoiditis. All patients were investigated preoperatively with MRI and intraoperatively with ultrasound. These neurodiagnostic examinations dictated the type of surgical intervention. Patients with Chiari I or Chiari II malformations, cervical hydromyelia, or basal arachnoiditis underwent decompression of the hindbrain malformations, myelotomy with drainage of the cyst, and placement of a stent. When the area of hydromyelia extended to the obex, as demonstrated by intraoperative ultrasound, the obex was plugged. Cyst-pleural shunts were placed in the children who had myelomeningoceles and thoracic hydromyelia. Patients with distal hydromyelia underwent modified terminal ventriculostomy. The classical presentation of brachial amyotrophy and dissociated sensory loss was present in only 3 patients. Progressive scoliosis without neurological deficit, pain, and Lhermitte's phenomenon were common presentations. The patients with tethered cords were generally asymptomatic from their cysts. The authors discuss operative technique, utilization of intraoperative ultrasound, and surgical outcome.
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PMID:Management of hydromyelia. 279 94

Lumboperitoneal (LP) shunts performed for communicating hydrocephalus have been reported to lead to neurologic deficits in the lower limbs and spinal deformities as a result of arachnoiditis. A chart review of 375 children who underwent LP shunts between 1960 and 1981 at The Hospital For Sick Children in Toronto was undertaken. Of the 375 charts reviewed, evidence of shunt-induced neurologic deficits was seen in 63 patients. Thirty-four patients had back pain with or without sciatica, 45 patients had hamstring tightness, and 40 patients had foot deformities. Forty-nine patients had lumbar hyperlordosis, lordoscoliosis, and scoliosis. These deformities are postulated to be the result of arachnoiditis involving the conus medullaris and lower lumbar roots.
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PMID:Orthopaedic complications of lumboperitoneal shunts. 319 96

To properly diagnose and treat the Chiari I malformation, it is necessary to know: 1) the position of the cerebellar tonsils; 2) the degree of compression of the upper cervical cord and medulla; 3) the status of the spinal cord, particularly whether a syringohydromyelic condition exists; 4) whether basal arachnoiditis is present; 5) the nature of the communication between the fourth ventricle and the subarachnoid space; and 6) the overall ventricular size. The use of computerized tomography (CT) alone is not sufficient to furnish all of this information. The addition of metrizamide to the CT study enables the exact delineation of the basic pathology of the Chiari I malformation and its associated complications. A total of seven patients with surgically proven Chiari I malformation were included in this study. In all of these cases, CT with metrizamide was the essential diagnostic procedure. Plain films appear to be necessary only to facilitate the diagnosis of an associated Klippel-Feil syndrome or scoliosis.
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PMID:Use of metrizamide in computerized tomography to diagnose the Chiari I malformation. 705 34

MRI is the best imaging method to evaluate syringomyelia. It is important to study from the posterior cranial fossa to the sacro-lumbar region and also the supra-tentorial structures. This complete analysis is essential to classify the syringomyelia and to investigate other associated malformations. Radiographs and CT scan are useful to analyze bone structures. For MRI, the new sequences with phased-array coils are also very important to study the entire spinal cord and the posterior fossa. It is essential to study the spinal cord with sagittal and axial spin echo T1 and fast spin echo T2 weighted images with sometimes coronal view, particularly when the patient presents a scoliosis, to have a correct morphological and functional evaluation. MRI gives an excellent study of the spinal cord with an excellent analysis of a primitive or foraminal syringomyelia, but also traumatic, infectious or post arachnoiditis syringomyelia. Spin echo T1 weighted images with injection of gadolinium can be used if an intra-medullary tumor is suspected. MRI is also useful for the post-operative follow up to evaluate the persistence of the medullary cyst and the enlargement of the foramen magnum.
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PMID:[Imaging of syringomyelia]. 1042 Apr 8

We describe two boys who had severe spinal complications in adolescence after a favorable initial recovery from neonatal Escherichia coli meningitis. Due to spinal granulomatous adhesions, one boy died after an attempted scoliosis operation (high cord lesion). The other showed severe progressive neurological deterioration with spinal and cerebellar symptoms. Conclusion The severe complication of chronic arachnoiditis with spinal adhesion may occur many years after neonatal acute bacterial meningitis.
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PMID:Neonatal Escherichia coli meningitis: spinal adhesions as a late complication. 1059 71

Split cord malformations (SCMs) may occur in conjunction with myelomeningoceles, and are often ignored or misdiagnosed, potentially causing spinal cord tethering. In this paper, we study the incidence and clinical significance of such an association. We have retrospectively reviewed the medical records and radiographs of 20 myelomeningocele patients who had a SCM. These comprised at least 6% of our myelomeningocele patients. Five of the 20 had simultaneous repair of both lesions at birth. The other 15 were diagnosed with the SCM in a delayed fashion (mean age 4.4 years). Clinical presentations that prompted a diagnostic investigation included hypertrichosis (1), pain (2), routine radiographic follow-up (2), neurourological deterioration (10) and progressive scoliosis (5). In 17 of the 20 patients, the SCM involved the placode or was within one level of it. Fifteen of these were in the area of the placode or one segment above it. Five of the 20 patients had hypertrichosis and 15 of the 20 patients had a bony midline septum (i.e. type I SCM). Several accompanying spinal dysraphic lesions also contributed to the tethering: thickened (previously inconspicuous) filum terminale (6), syringohydromyelia (5) and a neurenteric cyst with a benign teratoma (1). Arachnoiditis secondary to the prior myelomeningocele repair was found, as expected, in all 15 patients. However, in virtually all patients, there was also evidence of tethering at the level of the SCM. Long-term follow-up showed stabilization of preoperative symptoms and signs, whereas complications of the operation and clinical evidence of retethering were uncommon. Myelomeningocele patients should be screened with clinical examinations looking for hypertrichosis and with spinal radiographs preoperatively looking for evidence of SCM (bony midline septum and/or interpedicular widening not due to the myelomeningocele). Intraoperatively, the placode and the rostral spinal cord segment should be carefully inspected for an SCM and other dysraphic lesions.
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PMID:Split cord malformations in myelomeningocele patients. 1091 95