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

Anterior approaches for scoliosis are now frequent. Versatility in exposure is such that any segment may be approached from either side without significant difficulty or morbidity. Anterior spine surgery is an addition to the modern armamentarium by improving correction, insuring fusions, and allowing better alignment of the scoliotic spine. In the 1990s, scoliosis patients are beneficiaries of innovators of safe and sound anterior spine surgical practice.
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PMID:Anterior surgery in scoliosis. 813 54

8 children with a mean age of 13 years with paralytic scoliosis due to myelomeningocele (MMC) were operated on according to Zielke with anterior fusion and instrumentation. There were no infections. All fusions healed. The postoperative mean follow-up was 4 years. The average correction of the primary curve was 62 degrees. In 5 cases proximal curve progression required reoperation; posterior fusion with Harrington rods was also done. Our last 2 patients, primarily operated on with both an anterior and posterior fusion, had no postoperative progression. Anterior fusion according to Zielke as the only procedure cannot be recommended in the treatment of severe paralytic scoliosis due to MMC. We advise a combined anterior and posterior approach in these cases.
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PMID:Anterior fusion insufficient for scoliosis in myelomeningocele. 8 children 2-6 years after the Zielke operation. 845 38

Anterior thoracic discectomy procedures with endplate ablations and posterior spinal fusions are advocated for patients with severe scoliosis. These surgical procedures traditionally are accomplished through extensive open thoracotomy incisions. At Children's Hospital Medical Center, Cincinnati, surgical team members have used a minimally invasive procedure, video-assisted thoracoscopic surgery (VATS), to release the anterior spines of patients with scoliosis. This surgical technique has many benefits, including reduced blood loss, decreased postoperative pain, and improved postoperative pulmonary function. Perioperative nurses play key roles in the team approach to patient care through provision of preoperative education programs for patients and family members, organization of OR equipment, anticipation of possible intraoperative complications, and postoperative patient care planning. The implementation of a VATS program within an institution requires a significant financial investment and a long-term commitment to the ongoing education of OR personnel.
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PMID:Video-assisted thoracoscopic releases of scoliotic anterior spines. 865 68

Between 1948 and 1980, 107 of 164 patients survived after repair of congenital diaphragmatic defects. To study chest wall and spinal deformities among these patients, 60 survivors (mean age, 29.6 +/- 9.0 years) underwent clinical examination, chest and spinal radiography, spirometry, and diffusing capacity measurements. Twenty-seven of these patients also had body pletysmography, xenon 133 radiospirometry, and a test for bronchial hyperreactivity. Chest asymmetry was present in 29 patients (48%). Eleven patients (18%) had pectus excavatum, and one had a pectus carinatum deformity. Anterior asymmetry, pectus deformities, and a flat chest were more common among the patients who initially had a large diaphragmatic defect. Two patients underwent anterior thoracoplasty because of their deformities. Sixteen patients (27%) had significant scoliosis (Cobb angle > or = 10 degrees). Scoliosis was more common in patients with ventilatory impairment than in those with normal lung function. One patient required spinal stabilization, one with severe kyphoscoliosis remains under observation, and a patient with moderate scoliosis was treated with a spinal brace. The results of this study indicate that chest wall deformities and scoliosis are common among adults with repaired congenital diaphragmatic defects. In most patients the deformity is mild, but some will require surgery. Surveillance until adulthood is appropriate.
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PMID:Chest wall and spinal deformities in adults with congenital diaphragmatic defects. 878 22

Familial dysautonomia (FD) is a rare autosomal recessive disease occurring in Jews of Ashkenazi descent, with only some 500 recognized cases. The causative gene was identified on chromosome 9. FD is of considerable orthopedic interest, because of the prevalence of skeletal deformity. About 90% of surviving dysautonomic children will develop a spinal curvature, commonly a scoliosis. The scoliotic curve is usually kyphotic rather than lordotic, and appears during the first decade of life. Fifty-one of the 90 reported cases of familial dysautonomia in Israel involved patients who were seen at the scoliosis clinic for assessment and treatment of their spinal deformities. Most of the patients presented with a scoliotic deformity associated in 37 cases with an increased thoracic kyphosis. In our series orthotic treatment and physiotherapy were found to be minimally successful at best. Surgical treatment of the spine was performed in 13 of 51 patients in this series. A retrospective review of these patients' charts and radiographs was carried out. Six years of follow-up are reported. The primary indication for surgery was progression of the spinal curve. Only posterior spinal fusions were performed. Anterior transthoracic procedures were avoided in spite of the significance of the kyphotic deformity, because of the frequency of pulmonary complications. Harrington distraction and compression instrumentation was used. Three-millimeter compression rods were used in a distraction mode in thin, young children. "Harri-Luque" segmental sublaminar wiring technique and Wisconsin spinous process segmental wiring was used in some. In all cases, the spine fusion was supplemented by bank bone only, to avoid the additional trauma of graft removal. We believe that surgical intervention is advantageous, if done early in the evolution of spinal deformity. Greater technical difficulties and a higher complication rate were encountered in this series relative to the problems usually seen after spinal deformity surgery in children; this is all the more important in a disease in which general anesthesia is an additional major complicating factor. It is hoped that the improved physical condition now seen after early gastrostomy and fundoplication will aid in reducing this high complication rate. Only a small degree (about 25%) of correction was achieved in the majority of patients. Some of this apparent rigidity derived from the inability to apply sufficient instrumental corrective force because of the friable osteoporotic bone. After surgery, there was a marked decrease in the frequency of pneumonia and an improvement in the degree of ataxia, for reasons not understood, which led to an obvious improvement in the quality of life.
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PMID:Aspects of spinal deformity in familial dysautonomia (Riley-Day syndrome). 909 25

Anterior abdominal wall defects are not too rare between developmental abnormalities. A case of abdominal wall defect associated with complex malformations diagnosed prenatally is reported in the paper. In the present case of limb-body wall complex a right sided abdominoschisis was associated with rotational abnormality of the lower limbs, clubfoot, scoliosis, meningomyelocele, lack of developed pelvic organs, consecutive dilatation of the upper urinary tract, anal atresia, lack of external genitalia, lack of diaphragm and hypoplastic lungs. Review of the pertinent literature has revealed over 100 cases that clearly indicate the possible phenotypic variation of the limb-body wall complex. These data add further evidence to support the existence of two different phenotypes and possibly pathogenesis under the heading of limb-body wall complex. The three principal theories on the possible aetiology of the complex are also discussed. Because the limb-body wall complex is incompatible with life, it is important to diagnose the lesions prenatally, and to differentiate them from other anterior abdominal wall defects. Serum alpha-fetoprotein measurement, and ultrasonographic examination are the key to prenatal diagnosis.
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PMID:[Limb-body wall malformation complex: an unusual developmental abnormality of the abdominal wall. Case report, clinicopathological and etiological implications]. 931 98

Anterior spinal fusion (ASF) has been proven to improve curve correction, save motion segments, and decrease the rate of pseudarthrosis when compared with posterior spinal fusion alone. However, in patients with idiopathic scoliosis, the complication rate of the anterior approach to the spine using current techniques has only been scantly defined in the literature. This is a retrospective review of consecutive patients who underwent primary ASF for idiopathic scoliosis to determine the prevalence and types of complications specifically related to the anterior approach. All patients who underwent primary ASFs for idiopathic scoliosis done by one of two orthopaedic surgeons between October 1986 and July 1992 were reviewed. Adequate records were available for 98 of 103 patients. The average age at time of surgery was 22 years (range, 10-60 years). Complications were divided into three groups: major (resulting in permanent sequelae or necessitating a second major operation); minor (resulting in a prolonged hospital stay, necessitating a minor operation, and/or resulting in a significant temporary hardship or persistent minor problem); and insignificant (anything less than minor). One of 98 patients had a major complication (a pelvic deep venous thrombosis that required operative thrombectomy). Twenty-five of 98 patients had 28 complications classified as minor, and 28 of 98 patients had 30 complications classified as insignificant. Smoking was a significant risk factor for the development of minor complications. There was no statistically significant relationship between the development of complications and the degree of curve, the approach used, the procedure performed, or the performance of rib resections. The anterior approach to the spine in patients with idiopathic scoliosis in this series was very safe, with only one major complication in 98 patients. However, minor and insignificant complications were quite common, occurring in 45 of 98 patients (46%). Smoking was a significant risk factor for minor complications.
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PMID:Prevalence of perioperative complications after anterior spinal fusion for patients with idiopathic scoliosis. 935 51

A 48-year-old man suffering from paraparesis had congenital kyphoscoliosis due to fused wedged vertebrae between T2 and T4. The kyphoscoliosis consisted of left convex scoliosis measuring 26 degrees and kyphosis measuring 27 degrees. On CT-myelograms and axial MR images, the dura and spinal cord were deviated anterolaterally to the concave side of the curve around its apex. The spinal cord was stuck and flattened against the posterolateral margin of the vertebral body to the base of the pedicle with the posterior subarachnoid space preserved. Anterior decompression from the concave side through a transthoracic approach resulted in a remarkable neurological improvement. The paraparesis may have been caused by compression of the spinal cord through a tethering effect due to its developmental tightness around the apical vertebra and the additional tension created by motions of the neck.
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PMID:Paraparesis associated with mild congenital kyphoscoliosis in an adult. 954 31

A retrospective review was performed to determine "crankshaft" prevalence in 86 immature patients who underwent posterior spinal fusion for idiopathic scoliosis. Tanner stage, chronologic age, bone age, and epiphyseal status were used as maturity indicators. Overall, 62 (72%) patients progressed < or = 10 degrees, 18 (21%) patients progressed 11-15 degrees, and six (7%) patients progressed > or = 16 degrees in the coronal plane. Tanner I patients with open triradiate cartilage had the highest rate of crankshaft occurrence; nine (75%) of 12 patients progressed >10 degrees (p < 0.05). Fifty-two percent of Tanner I, 26% of Tanner II, 11% of Tanner III, and no Tanner IV patients progressed >10 degrees (p < 0.05). Cobb angle increases of >10 degrees degrees occurred in 54% of patients with open triradiate cartilage (p < 0.05) and in 48% of patients with open capital femoral epiphyses (p < 0.05). Anterior and posterior spinal fusion should be considered in prepubertal (Tanner I) patients with open triradiate cartilage.
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PMID:Curve progression in Risser stage 0 or 1 patients after posterior spinal fusion for idiopathic scoliosis. 959 72

A meta-analysis of the acute correction outcomes in adolescent idiopathic scoliosis is reported. Posterior instrumentation systems generally gave similar coronal plane corrections with average corrections for differing systems ranging from 48% to 67%. There was significant overlap of corrections reported for each of the systems. Anterior instrumentation gave better results with average corrections ranging from 71% to 93%. No instrumentation demonstrated a consistent ability to restore a normal thoracic kyphosis, but all seemed to maintain preoperative kyphosis measures. All systems, including newer multihook systems, showed a small loss of lumbar lordosis postoperatively. The available data demonstrates that no posterior implant produces vertebral derotation.
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PMID:Surgical corrections in scoliosis: a meta-analysis. 959 85


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