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

Sixty patients with congenital deformities of the spine were operated upon in the past fifteen years using a two-stage procedure. In the fifty patients with scoliosis half of the deformities were due to hemivertebrae and half to unilateral bars. The average correction of the deformity was 47 per cent. Early neurological signs observed in two patients with a diastematomyelia resolved. Of the ten patients with kyphosis nine had neurological signs of impending paraplegia and one was completely paraplegic before operation; all improved markedly. Posterior spinal fusion alone in the rapidly progressing congenital deformity may not prevent further progression, particularly in those cases iwth unilateral bars. Anterior resection of the vertebral body with later posterior fusion with Harrington instrumentation is safe and effective.
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PMID:Two-stage corrective surgery for congenital deformities of the spine. 47 55

The greatest need for anterior spine surgery is for those cases that have neurological involvement with pressure or stress forces exerted on the spinal cord. With anterior decompression excising anomalous bone, shortening the spine with posterior osteomies, and correction with Harrington instrumentation, many of these cases were protected against neurological sequelae as well as correction of the deformity. Anterior spine reconstruction is a 2-stage procedure. The procedure protects against damage to the blood supply, untethers the spinal cord, corrects deformity, and stabilizes the spinal column. As more cases that can benefit from anterior spine correction of scoliosis are recognized, the expertise to deal with these lesions continues to grow.
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PMID:Current status of anterior spine surgery for scoliosis. 59 45

The incidence of scoliosis in cerebral palsy is related to the severity of the neurological involvement, being most prevalent in patients with spastic quadriplegia. Neuromuscular spinal deformity, when present, may progress after cessation of skeletal growth, and the success of orthotic treatment for scoliosis is unpredictable. Hip pathology is directly related to pelvic obliquity but has no causal relationship to the development of scoliosis. Adequate preoperative nutritional assessment is vital to reduce perioperative complications, and segmental spinal fixation is the instrumentation of choice. Anterior arthrodesis is indicated for rigid deformities and for those thoracolumbar and lumbar curves extending into the pelvis with pelvic obliquity and spinal decompensation.
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PMID:[Spinal disorders in cerebral palsy--surgical procedure]. 140 24

Forty patients underwent 47 procedures for repair of a lumbar pseudarthrosis at the University of Minnesota, Twin Cities Scoliosis Center between 1973 and 1986. Forty-three procedures in 36 patients with a minimum follow-up of 2 years were reviewed. Symptoms at the time of surgery included back pain (100%), leg pain (61%), subjective neurologic symptoms (49%), and thigh pain (35%). The diagnosis was made most commonly on the basis of pain radiographs (70%). In 38 cases, posterolateral fusion was performed, using segmental sublaminar wiring in 37%, a variable screw plate in 29%, Harrington compression rods in 16%, and no implant in 18%. Anterior interbody fusion was performed in six cases, including one combined fusion. Follow-up averaged 4.4 years. Solid fusion was achieved in 49% of cases. Eighty-six percent of patients continued to have low-back pain. Clinical outcomes were graded as excellent in 7%, good in 35%, fair in 9%, and failure in 49%. Significantly improved results were seen in patients in whom a solid fusion was obtained (p less than 0.005), in patients who had undergone only one prior surgery on the lumbar spine (p less than 0.01), and in patients in whom the initial fusion had been performed for spondylolisthesis rather than a primarily degenerative disorder (p less than 0.025). A trend toward better results was seen in cases in which the patient did not complain of leg pain preoperatively, in which a Workers' Compensation claim was not involved, and in which a prior attempt at pseudarthrosis repair had not been performed.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Results of lumbar pseudarthrosis repair. 153 4

Factors favoring development of the crankshaft phenomenon after posterior spinal fusion include immaturity and large residual deformity. Eight patients at high risk to develop the crankshaft phenomenon underwent periapical anterior growth arrest and fusion before posterior instrumentation and fusion. With follow-up to skeletal maturity, 0% developed crankshaft phenomenon. Anterior growth arrest and fusion before a posterior procedure is recommended in scoliosis patients at high risk to develop the crankshaft phenomenon.
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PMID:Prevention of the crankshaft phenomenon. 178 96

On the basis of a study of the literature and observations in 53 of our own patients, we attempted to establish the cause and best treatment for neuropathic oblique pelvis. In addition, we tried to find out if certain kinds of neurologic dysfunctions coincide with certain kinds of oblique pelvis. It is highly probable that this pelvis malformation is the result of neuropathic spinal deformity. Severe oblique pelvis and scoliosis can be related to the severity of the neurologic dysfunction. Hip dislocation is not the reason for oblique pelvis. It can be assumed that hip dislocation, on the one hand, and oblique pelvis and scoliosis on the other can influence each other. To correct oblique pelvis, the neuropathic spinal deformity must be corrected. Anterior and posterior fusion, including the lumbosacral junction, give the best results.
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PMID:[Pelvic tilt in neuromuscular diseases]. 223 61

Since 1973, 50 of 54 children have been treated by the author with a combined anterior and posterior fusion. Twenty males and 34 females, ranging in age from 1 to 16 years, have been followed for a mean period of 5.5 years. Sixteen patients with a kyphosis averaging 113 degrees (range, 77 to 170 degrees) had correction of deformity to a mean of 35 degrees. Thirty-seven patients with a scoliosis averaging 73 degrees (range, 20 to 135 degrees) had correction to an average of 34 degrees (range, 0 to 75 degrees). There were 4 cases of deep wound infection successfully treated with drainage and antibiotics and only one case required implant removal after fusion/maturation. A pseudarthrosis was noted by radiograph in 6 patients, 3 of whom had isolated asymptomatic lumbosacral pseudarthroses. Three patients had pseudarthrosis at the thoracolumbar junction. These required repair and were successfully treated by supplemental posterior fusion resulting in an overall pseudarthrosis rate of 5.7%. Anterior fusion of the dysraphic spine allows greater correction of both spinal deformity and pelvic obliquity in addition to contributing significant strength to the fusion mass. Segmental spinal instrumentation with sublaminar and pedicular wiring to custom-contoured Luque rods provides excellent correction and immediate postoperative stability.
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PMID:Combined anterior and posterior fusion for spinal deformity in myelomeningocele. 225 86

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

Chest wall deformities developed after thoracotomy for esophageal atresia, in 77 of 232 patients (33%) who did not have a congenital vertebral anomaly. Anterior chest wall asymmetry was present in 47, scoliosis in 18 and a combination of both in 12 patients. Scoliosis was convex away from the incision in two thirds of those affected. Anterior chest wall deformity was more common in patients greater than 25 years of age, and scoliosis was more common in patients who had had multiple thoracotomies. Breast surgery to minimize inequality was required in three female patients, and spinal surgery in one patient. Twenty-two of 53 patients with a congenital vertebral anomaly developed scoliosis, eight of whom required surgery. The scoliosis was probably the result of the vertebral anomaly in these patients, who are particularly at risk for progressive deformity.
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PMID:Chest wall deformity in patients with repaired esophageal atresia. 270 86

From 1958 to March 1987 we corrected 704 patients with pectus excavatum. The condition occurred more frequently in boys (544 patients) than girls (160 patients). In the majority of patients (86%), the defect was evident at birth or within the first year of life. Musculoskeletal abnormalities were identified in 133 patients (scoliosis, 107; kyphosis, 4; myopathy, 3; Poland's syndrome, 3; Marfan's syndrome, 2; Pierre Robin syndrome, 2; prune belly syndrome, 2; neurofibromatosis, 3; cerebral palsy, 4; tuberous sclerosis, 1; and congenital diaphragmatic hernia, 2). Sixteen patients had associated congenital heart disease. A family history of chest wall deformity was present in 37% of the cases and a history of scoliosis in 11%. Surgical correction was performed using a uniform technique for bilateral subperichondrial resection of the deformed costal cartilages and sternal osteotomy resecting a wedge of the anterior cortex and fracturing the posterior cortex. Anterior displacement was maintained with silk sutures closing the osteotomy defect. In 28 early cases, the sternum was secured by intramedullary fixation with a Steinman pin. All repairs were completed with a low complication rate (4.4%; pneumothorax, 11; wound infection, 5; wound hematoma, 3; wound dehiscence, 5; pneumonia, 3; seroma, 1; hemoptysis, 1; hemopericardium, 1). Six complications were associated with Steinman pin fixation (hemoptysis, seroma, hemopericardium, pneumothorax, 3). Major recurrence occurred in 17 patients (2.7%) and led to revision in 12. Satisfactory long-term results were achieved in the remaining 687 patients, with follow-up ranging from 2 weeks to 27 years. Mean follow-up was 4.3 years.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Surgical repair of pectus excavatum. 320 60


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