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)

There are many current strategies for normalizing coronal and sagittal profile in the idiopathic adolescent and adult scoliosis patient. Anterior and posterior approaches have their advantages and limitations. Many factors have to be considered in determining the "best" approach, as idiopathic scoliosis presents with a wide diversity of deformity and curve pattern. Those points are reviewed in this manuscript.
 ...
PMID:Normalization of the coronal and sagittal profile in idiopathic scoliosis: options of treatment. 965 66

A series of patients with single major scoliosis curvatures attributable to spina bifida treated by anterior only spinal fusion was studied for 2 years to determine whether the infection rate could be decreased, adequate correction and pelvic balance could be provided, and posterior surgery could be avoided in these patients. Anterior surgery alone was performed for thoracolumbar scoliosis greater than 45 degrees if the compensatory thoracic curve was less than 40 degrees and there was no significant junctional kyphosis. Fourteen patients were treated at a mean age of 11.9 years (range, 7-16 years), with a mean curve of 64 degrees (range, 51 degrees-85 degrees), and motor levels distributed from T10-L4. Thirteen patients had prior neurosurgery for tether, syrinx, or Arnold-Chiari malformation. The spine was fused over a mean of seven vertebrae. A 3/16 inch Texas Scottish Rite Hospital rod was used most commonly (10 patients). Blood loss averaged 1100 cc. The mean curve correction was 57% at 40 months after surgery. Loss of correction occurred primarily by adding on outside the instrumented area. Mean pelvic obliquity was improved from 16 degrees to 9 degrees. There was one superficial infection. Results were good in five patients, fair in four, and poor in five. Failures were attributable to proximal decompensation in two patients who required revision surgery (two), neurologic deterioration in two, and screw pullout in one. Both patients with decompensation had syringomyelia. Both patients with neurologic deterioration had large curves (> 75 degrees). Both patients recovered after rod removal. Retrospectively, by eliminating patients with syrinx or with a curve greater than 75 degrees, all poor results would be eliminated. Anterior only fusion and instrumentation may have significant advantages, but only for selected patients with thoracolumbar curves less than 75 degrees, compensatory curves less than 40 degrees, no increased kyphosis, and no syrinx. Quadriceps function should be monitored. On the basis of this preliminary experience, continued use of this approach using stricter selection seems warranted.
 ...
PMID:Anterior only fusion for scoliosis in patients with myelomeningocele. 1041

Anterior instrumentation is recommended to correct idiopathic thoracolumbar or lumbar scoliosis through short fusion within the major curve. Only a few reports exist of anterior surgical correction for thoracic scoliosis. This study assessed the results of Zielke instrumentation for thoracic curve and analyzed the three-dimensional correction of deformity, especially correction of the uninstrumented compensatory curve. Seventeen patients, who had undergone selective thoracic correction and fusion using the Zielke procedure to treat thoracic scoliosis, had been followed for at least 3 years. Three-dimensional correction was evaluated radiographically. Furthermore, three-dimensional back deformities were evaluated using a topographic body scanner. Twelve patients with a single thoracic curve and five with a double curve were all female, with a mean age of 14.6 years. The preoperative main thoracic curve was 54.8 degrees +/- 10.5 degrees (range, 40-78 degrees), and it was 23.8 degrees +/- 10.5 degrees (range, 7-40 degrees) at the final follow-up examination (p < 0.0001). The average correction rate of the main curves was 56.6%. By correcting the thoracic curve, the upper and lower compensatory curves were corrected spontaneously without surgical instrumentation, with average correction rates of 45.1% and 50.2%, respectively. The average correction loss of the main curve was 2.3 degrees. The hump angle measured using a topographic body scanner decreased from 12.8 degrees +/- 4.5 degrees to 8.4 degrees +/- 4.3 degrees after surgery (p = 0.0001). Of the three patients in whom the rod broke up, only one showed a correction loss of 10 degrees; however, bony fusion was obtained. Anterior short fusion for thoracic scoliosis appears to offer significant correction, stabilization, and spontaneous correction of the compensatory lumbar curve without limiting lumbar motion.
 ...
PMID:Anterior surgery with short fusion using the Zielke procedure for thoracic scoliosis: focus on the correction of compensatory curves. 1059 84

Spine deformities are a frequent symptom of neurofibromatosis Recklinghausen. Especially NF1 shows next to numerous alterations in the skeleton in some cases massive scoliosis and kyphosis. There are different theories for the development of the spine deformities, one of them is that specific alterations of the vertebra are caused by an elevated intraspinal pressure on the osteoporotic bone. A classification from a clinical point of view discriminates 3 types of severity. Type 1 shows instead of the in x-rays inconspicuous findings neurofibromatosistypical alterations in other diagnostic procedures (e.g. MRI). Extreme variations like short curved scoliokyphosis with massive destruction and severe spine imbalance are described as type 3. Operative treatment is dependent on the severity of the deformity. Intraspinal tumors have to be removed. Because of the elevated neurological risk the proceeding has to be very careful, sometimes there is a temporary Halo-extension necessary. Anterior substance defects are filled with bone or cages. The posterior instrumentation (in most of the cases a 2-rod-stabilization) is performed by transpedicular screws. Frequently there is a concave chest wall plastic (CTP) indicated. To prevent neurological complications early surgical procedure is sometimes necessary. Complications can be reduced by careful proceeding, exact preoperative diagnostic and classification. But next to operative experience a qualified anaesthesiological and intensive care units are absolutely necessary.
 ...
PMID:[Treatment of scoliosis and scoliokyphosis in Recklinghausen neurofibromatosis]. 1092 33

Anterior instrumentation for the correction of scoliotic curves has recently been gaining in popularity. The problems of high mortality and morbidity that were associated with the employment of anterior instrumentation in the first years it was used have now been overcome. Efforts are now being concentrated on increasing the correction rates in the frontal plane and decreasing the kyphotic effect in the sagittal plane. The anterior Cotrel-Dubousset-Hopf (CDH) system is a recently developed instrumentation that has been claimed to decrease the kyphotic effect through the use of double rods. This study aimed to investigate the impact of the anterior CDH system on idiopathic scoliotic curves in frontal and sagittal planes. To this end, 26 idiopathic scoliosis patients treated with the CDH system were followed for a mean period of 32.8 +/- 5.3 months. In the frontal plane, Cobb angles of major and secondary curves were measured, and postoperative and final correction rates determined. In the sagittal plane, sagittal contours of both the instrumented region and the thoracic and lumbar regions were measured, and their preoperative, postoperative and final control values were determined. In addition to clinical examination, lateral trunk shift (LT), shift of head (SH) and shift of stable vertebra (SS) were measured in vertebral units (VU), on the preoperative and postoperative radiographs in order to evaluate the effect of the system on trunk balance. It was established that in patients with single flexible thoracolumbar and lumbar curves and those with rigid thoracic curves, the correction rates obtained in the frontal plane were respectively 79.4 +/- 14.8%, 68.0 +/- 9.4% and 61.5 +/- 8.0%, with statistical significance. Their final corrections at the last control were 76.3 +/- 17.4%, 56.9 +/- 9.1% and 52.3 +/- 8.3%, respectively. Although the corrections in the lumbar rigid curves were relatively low, they were still statistically significant. Taking all the patients together, the mean preoperative Cobb angle of the major curves of 67.2 degrees +/- 20.2 degrees improved to a mean of 28.6 degrees +/- 21.0 degrees, which was a statistically significant difference (P < 0.05), giving a mean correction rate of 61.2 +/- 20.3%. The mean correction loss of major curves in the frontal plane in all patients was 6.0 degrees +/- 3.8 degrees and the mean final correction rate was 52.6 +/- 23.2%. In the sagittal plane, there was a favorable kyphotic effect on the thoracic region of patients with hypokyphosis and lordosis pattern, whilst in patients with kyphotic pattern, this effect was minimal. In patients with a single flexible lumbar curve, kyphotic effect was not observed except in two patients. In these two patients, it was thought that excessive compression force may have been used. As to the pa tients with rigid lumbar curve. there was a slight decrease in lumbar lordosis. No postoperative complaints were made about imbalance. and the mean overall correction in LT values was 60.1 +/- 21.7%. While preoperatively, the SH and SS values of all patients were over 0.5 VU, postoperatively, 12 patients (46.2%) were completely balanced (SH = 0 VU, SS = 0 VU) and 8 patients (30.8%) were balanced (0 VU < SH and SS < 0.5 VU). The remaining six patients, whose balance values were corrected with statistical significance but were still over 0.5 VU, were found to be the ones with rigid lumbar curves. Implant failure and systemic complications were not noted in the follow-up period. In view of these findings, it was determined that CDH instrumentation achieves significant correction rates in the frontal and sagittal planes, particularly in single flexible lumbar, thoracolumbar and thoracic rigid curves. It was found that the kyphotic effect was minimized with a double rod system. Significant clinical and radiological corrections were achieved in balance values, without any imbalance and decompensation problems.
 ...
PMID:The results of anterior fusion and Cotrel-Dubousset-Hopf instrumentation in idiopathic scoliosis. 1118 19

Segmental spinal instrumentation with Harrington rod secured to the spine by sublaminar wires was a popular method of scoliosis correction in 1980's. It was gradually replaced by newer rod-hook systems due to concern about neurological complications. However, correction of type II and III curves by selectively fusing the thoracic curves with these new instruments has resulted in poor results in some cases. The aim of this study is to review the result of selective thoracic fusion treated by segmental spinal instrumentation. Between January 1989 to October 1994, 31 patients with King II scoliosis were treated operatively in our unit. These consisted of 29 girls and 2 boys. The mean age of these patients were 11.3 years. The study population consisted of 21 Chinese, 5 Malays and 5 Indians. In one patient, the thoracic curve was convex to the left whilst the thoracic curves in the majority were to the right. The surgery was performed by three surgeons using harrington rods and posterior fusion with autograft. Anterior releases were also required in eight patients to increase flexibility. The curve correction obtained was an improvement from a average preoperative cobb's angle of 71.5 degrees to 39.5 degrees postoperatively. After an average follow-up period of 77.9 months, the correction deteriorated by 22% in the thoracic curve and 59% in the lumbar spine without disturbance to truncal balance. Only one sublaminar wire broke. However, no implant failure or removal has to be performed as yet. This technique appears useful in our institution with minimal morbidity.
 ...
PMID:Selective thoracic fusion of King II scoliosis with segmental spinal instrumentation. 1120 41

Lumbar radiographs of 120 adolescent elite skiers were evaluated for radiologic abnormalities by two independent observers. All athletes had no symptoms before the study. Radiographs were taken before enrollment of the students in elite level training. To determine the clinical significance of these abnormalities, all athletes were observed prospectively during the subsequent 2-year period for development of low back pain under high performance training. Anterior end plate lesions, Schmorl's nodes, posterior end plate lesions, spondylolysis, scoliosis, and spina bifida occulta were found. The depth of anterior end plate lesions showed a two-peak distribution, with peaks at 11% and 22% and a valley at 18% vertebral body height. The overall low back pain incidence was 12.5%. Students with severe anterior lesions (greater than 18% vertebral body height, n = 25) had significantly more low back pain (incidence, 32%) than did students without severe anterior lesions (incidence, 7.4%). Accordingly, students with severe anterior lesions had a significantly higher risk of having low back pain develop. Moderate end plate lesions and other abnormalities were not related to an increased incidence of low back pain. Adolescent students of elite sports with severe lumbar anterior end plate lesions have an increased risk of having low back pain develop under high performance training.
 ...
PMID:Radiologic abnormalities and low back pain in elite skiers. 1155 Aug 61

The frequent occurrence of osteoporosis in Rett syndrome raises questions about the etiology of this finding. It is unknown whether there is any relationship between low bone mass and the underlying genetic disorder. We recently had an opportunity to study the status of bone remodeling by quantitative bone histomorphometry in three girls ages 9.75, 13.5, and 14 years, with typical Rett syndrome who required scoliosis surgery.Anterior iliac crest bone biopsies were performed 1-2 days after double labeling of the bone surfaces with tetracycline. Samples were processed for plastic embedding, sectioned, stained, and histomorphometry performed in the cancellous bone. The same observer performed all measurements. Bone volume was reduced, surface parameters of formation (osteoid surface) were normal while parameters of resorption (osteoclast surface and number) were decreased. The rate of bone formation was reduced in the first two girls but could not be measured in the third girl due to lack of double labeling. It may be that the slow rate of bone formation seen in each age group impedes the development and accumulation of peak bone mass and contributes to the decreased bone volume associated with Rett syndrome, although the data is limited. This is the first report to document decreased bone volume determined by quantitative bone histomorphometry in patients with Rett syndrome. With the recent identification of MECP2 mutations in Rett syndrome it is quite likely that genetic factors not only play a major role in brain development but may also influence other organ growth including bone formation.
 ...
PMID:Bone histomorphometry in three females with Rett syndrome. 1173 59

Congenital anomalies of the spine usually originate in (toxic) disturbances during pregnancy. There are occasional hereditary types. These are characterized by the presence of multiple anomalies. Congenital scolioses are often associated with other anomalies like spinal dysraphy (20-30%) and fusion of the ribs. Furthermore heart defects, Sprengel's deformity, cleft palates, hemimelias, clubfeet or congenital vertical talus are frequently associated with congenital scoliosis. We classify in failures of formation, segmentation and combined types. The type of malformation determines the prognosis. One hemivertebra is associated with a risk of progression of 0-2 degrees/year, 2 ipsilateral hemivertebra with 2-3 degrees/year, a unilateral unsegmented bar with 5 degrees/year and a combination of a unilateral unsegmented bar with a contralateral hemivertebra with approximately 10 degrees/year. Conservative treatment is usually ineffective. The indication for operative treatment should be made before the deformity becomes unacceptable, as a correction is difficult and dangerous. The following operations can be carried out: Anterior and/or posterior fusion with or without instrumentation, epiphyseodesis, (hemi)vertebrectomies (with anterior and/or posterior approach), distraction with a halo, osteotomies, separation of the fused ribs and gradual distraction (Campbell's expansion thoracoplasty). The operations carry significant risks and the indication to the various treatment modalities is difficult. Operations should be made under monitoring of sensory and motor evoked potentials. From 498 patients with congenital anomalies of the spine in our observation we have operated on 143. Hemivertebrectomies were the most frequent interventions (56).
 ...
PMID:[Congenital anomalies of the spine]. 1196 67

A review was carried out on 59 patients (10 males and 49 females) who had anterior interbody fusion performed with femoral ring allograft packed with autograft bone chips with a minimum follow up of 2 years. The average age at the time of surgery was 49.1 year old (26 to 75). The total number of levels grafted was 141. The diagnosis consisted of multiple degenerative disease in 6, degenerative change below the long segment of fusion for scoliosis in 9, osteoporosis with collapsed fracture in 3, pseudarthrosis after posterior laminectomy and fusion in 35, congenital scoliosis in 3, scoliosis in 2 and paralytic scoliosis due to multiple sclerosis in one. The distribution of levels fused was T12-L1 in 6, L1-2 in 12, L2-3 in 17, L3-4 in 22, L4-5 in 35 and L5-S1 in 39. The remaining 10 levels were in the lower thoracic areas (T7-T12). The operations were performed as anterior fusion alone in 13 patients, one-stage anterior and posterior fusion in 26 patients and two-stage surgery in 20 patients. Anterior instrumentation was used in all 141 levels. At average follow-up (33.7 months) there was no significant change in allograft angles (average = 1.6 degrees ). Fusion of the allograft was classified by Bridwell's grading system. At 24 months of the follow up, 97 % of the allografts were in grade I (fully incorporated) and 3% were in grade II (partially incorporated). Compared to 12 months follow-up only 76.2% of the grafts were in grade I, 28 % were in grade II and 0.8% were in grade III. Two patients had deep posterior infections which required further surgery (without resorption of the allograft anteriorly). One patient had a screw migration anteriorly which required removal. Three patients had persistence of radiolucent line at one of the vertebral end plates - graft interfaces but no subsidence of the graft or pain. In conclusion, the femoral ring allograft appeared to benefit the anterior interbody fusion in complex spinal surgery.
 ...
PMID:Role of femoral ring allograft in anterior interbody fusion of the spine. 1211 23


<< Previous 1 2 3 4 5 6 7 8 Next >>