Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0700208 (scoliosis)
 8,574 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Fifty-nine adult patients were examined who had undergone previous spine surgery for scoliosis but in whom pain (78 per cent), loss of correction (68 per cent), or dyspnea (36 per cent) subsequently developed. Twenty-six patients had idiopathic scoliosis, twenty-five had paralytic scoliosis secondary to poliomyelitis, and eight had scoliosis secondary to miscellaneous etiologies. A one-stage reconstructive procedure was performed in sixteen patients and a two-stage procedure, in forty-three patients. The two-stage procedure consisted of exposure of the spine and multiple osteotomies, followed by two weeks of halofemoral traction to obtain correction. The spine fusion was then extended, using Harrington instrumentation to maintain correction. At an average follow-up of 3.3 years there was reduction of pain in 67 per cent of the patients and a solid fusion in all but two. The complication rate was high (71 per cent), the most important complications being pseudarthrosis, wound infection, urinary tract infections, loss of lumbar lordosis, and pressure sores. The mortality rate was 3.4 per cent. No patient became paraplegic at the initial surgical procedure and early recognition and treatment of pseudarthrosis will reduce the number of patients requiring this salvage operation.
 ...
PMID:Reconstructive surgery in the adult for failed scoliosis fusion. 51 76

A computerized pressure plate system was used to analyze the sitting pressure distribution and balance of 100 subjects with both normal and abnormal spines. Normal subjects had a balanced sitting posture with the weight taken evenly on each ischial tuberosity. Patients with idiopathic scoliosis showed significant sitting imbalance especially in the presence of lumbar curves. Bracing improved the sitting balance and stability in most patients. Abnormal sitting patterns were seen with the spinal deformities of myelodysplasia or cerebral palsy. Some patients with severe scoliosis had very asymmetric patterns, which correlated with their loss of sitting stability. The kyphosis of myelodysplasia produced an abnormal tripod sitting pattern due to pelvic flexion and a hyperlordosis of cerebral palsy a pubic sitting pattern due to pelvic extension. The patients studied after spinal fusion also had poor sitting balance and occasionally persisting decubitus ulceration.
 ...
PMID:Sitting balance in spinal deformity. 141 65

Correction of spinal deformities in patients with myelomeningoceles (mmc) is notoriously complicated. To identify the deformity, frequency, gravity and complications of treatment a retrospective study was carried out on 61 patients from four hospitals. 45 patients had neurological defect above L3 and were wheelchair-bound. The indications for surgery were progressive disturbance in sitting balance, pain and pressure sores. Two types of spinal deformity were identified; scoliosis (often thoraco-lumbar or double major curves) and kyphosis (usually angular and lumbar). The mean age at operation was 12 years 8 months (2y 6m-19y 7m). Several operative procedures were used; posterior, anterior and circumferential fusion, and resection of the kyphosis. 52 solid fusions were achieved with variable correction at the cost of many complications such as excessive blood loss (2), post-operative pressure sores (15), failure of instrumentation (15), deep infection (11), and death following a CSF leak (1). 4 patients died from unrelated causes. Only 16 patients had no complications. The type and severity of scoliosis and kyphosis, operative technique, results and complications were correlated to identify the risks and define the optimal surgical technique for each type of spinal deformity in mmc.
 ...
PMID:Treatment of spinal deformity in myelomeningocele: a retrospective study in four hospitals. 148 38

The correction of posttraumatic kyphosis in the thoracolumbar region almost always requires a combined anterior and posterior approach because of the particular anatomic situation and the pathomorphologic changes. We suggest that the patient be placed in a right lateral decubitus position. This allows dual access to the spine by a posterior midline approach and a retroperitoneal thoracolumbar approach, so that simultaneous anterior and posterior manipulation, correction and stabilization of the spine are possible with no need to turn the patient intraoperatively. Thus, compared with two-or three-stage procedures, the duration of the operation and of stay in hospital can be reduced. This is a retrospective review of the first six patients (average age: 35 years) treated with this approach between 1987 and 1990. All patients suffered from incapacitating back pain that was unresponsive to nonoperative treatment. The surgical procedure was performed at an average of 29 months (range, 5 months to 7 years) after fracture. The average postoperative correction of kyphosis (18 degrees to 45 degrees) was 75%. In addition, two patients had posttraumatic scoliosis (10 degrees and 12 degrees), which was completely corrected. The only complication was partial fracture of a vertebral body in one case, which occurred during the reduction manoeuvre but had no consequences. Three of the patients had complete relief of pain. The remaining three reported persistent pain, although they had good objective clinical and radiological results. The failure to eliminate pain in these patients is thought to be a result of their long-standing (2-7 years) symptomatic posttraumatic deformities. Therefore, we feel that early correction of symptomatic kyphosis is mandatory.
 ...
PMID:[Technique of surgical correction of post-traumatic kyphosis]. 156 93

Nine patients with a thoracolumbar, progressing, paralytic kyphosis, pressure sores from gibbus, an inability to lie on the back, and deterioration of the sitting balance were operated on with resection of two to three vertebrae and a thoracolumbar fusion. One child died from intracranial bleeding caused by a halo screw. There were no implant loosenings or non-unions. Pressure sores healed, sitting improved, and lying on the back became possible. A mild scoliosis above the fusion level developed in 2 patients, but neither of them needed any treatment.
 ...
PMID:Vertebral resection and fusion for paralytic kyphosis. 9 patients followed up for 6 (2-14) years. 176 37

One hundred patients with severe cerebral palsy (total body involvement) and dislocated hips were examined to determine their level of pain, sitting ability, pelvic obliquity, scoliosis, nursing care difficulties and complications of decubitus ulcers and fractures. 50 of the patients had undergone surgical procedures to treat the hip; 50 had received no treatment. No significant differences were found in the frequency of pain or other complications between the two groups. Nursing care difficulties and the ability to sit did not depend on the status of the hip. Pelvic obliquity and scoliosis were related to the severity of neurological damage rather than to hip stability. These findings suggest that surgical treatment of already dislocated hips of patients with severe cerebral palsy is not helpful.
 ...
PMID:Treated and untreated unstable hips in severe cerebral palsy. 210 51

Seventy-four patients who had deformity of the spine secondary to a neuromuscular disorder were treated using posterior fusion with Luque-rod segmental instrumentation. The mean curve was 73 degrees preoperatively and 38 degrees postoperatively. The mean loss of correction was 4 degrees at an average duration of follow-up of forty-two months (range, 2.0 to 7.3 years). Complications included one death, three deep wound infections, two pressure sores, six sets of broken rods, and one instance of distal rotation and migration of the rod. There were no major perioperative neurological complications. Failure of instrumentation occurred more frequently with 3/16-inch (4.8-millimeter) diameter than with 1/4-inch (6.4-millimeter) diameter stainless-steel rods. There was a tendency for cephalad progression of deformity when the fusion ended cephalad at or below the fourth thoracic vertebra. We concluded that Luque-rod segmental instrumentation with posterior spinal fusion is an effective treatment for patients who have neuromuscular scoliosis.
 ...
PMID:Spinal fusion augmented by luque-rod segmental instrumentation for neuromuscular scoliosis. 291 1

The distribution of pressure points in 16 patients with paraplegia, nine with ulcers, and six who were ulcer free were compared with the distribution in 15 normal individuals using an instrument capable of simultaneously measuring multiple pressure points under the buttocks and thighs. The nine patients with ischial and sacral decubiti showed redistribution of their sitting pressures posteriorly, asymmetrical loading of the ischiae, and higher than normal pressures under the sacrococcygeum. These abnormal pressures were associated with unbalanced scoliosis, pelvic obliquity, and the loss of physiological lordosis following a spinal fusion. We defined four criteria of risk for decubitus ulceration.
 ...
PMID:Relationship of spine deformity and pelvic obliquity on sitting pressure distributions and decubitus ulceration. 389 15

The incidence of pain and other complications associated with the untreated spastic dislocated or subluxed hip was investigated in 80 institutionalized patients. The average patient age was 19 years, and the average length of follow-up study was 12 years. Eighty-five percent of the patients had scoliosis, and 56% had significant pelvic obliquity. A dislocated hip predisposed to lower extremity fractures but did not present problems of pain, decubitus ulcers, or difficulties with perineal hygiene. The loss of sitting balance, scoliosis, and pelvic obliquity are correlated with the severity of neurologic involvement rather than with the mechanics of a dislocated hip.
 ...
PMID:The untreated unstable hip in severe cerebral palsy. 682 28

The spines of forty patients with myelomeningocele and paralytic scoliosis were surgically stabilized at the Twin Cities Scoliosis Center between 1960 and 1979. Treatment with posterior spine fusion and Harrington instrumentation extending to the sacrum, combined with anterior fusion using either Dwyer or Zielke instrumentation, gave the best results, correcting scoliosis by an average of 45 degrees (comparing preoperative values with those at the last visit), lordosis by an average of 20 degrees, torso decompensation by an average of 5.7 centimeters, and pelvic obliquity by an average of 7 degrees. This combined fusion method reduced the rate of pseudarthrosis to 23 per cent (compared with 46 per cent when only posterior fusion and instrumentation were used). Prophylactic antibodies (selected on the basis of preoperative cultures of urine) reduced the infection rate to 8 per cent. Posterior fusion or anterior fusion alone was inadequate, even with instrumentation. Early mobilization wearing a bivalved polypropylene body jacket minimized osteoporosis, pressure sores, and social isolation. Unsolved technical problems remain, however, especially in relation to obtaining fusion across the lumbosacral joint.
 ...
PMID:Surgical treatment of paralytic scoliosis associated with myelomeningocele. 704 31


1 2 3 Next >>