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

The authors report the development of an extensive right chylothorax several days after Dwyer's anterior instrumentation in a 6-year-old girl with a severe progressing infantile scoliosis. Instrumentation extended from T11 to L4 with removal of the tenth rib and with splitting of the diaphragm. The postoperative course was initially without any problems. However, respiratory distress on the tenth day after surgery was accompanied by mediastinal shift and the symptoms were relieved with aspiration of 600 ml of chyle from the right pleural cavity. The literature on this complication of chylothorax is reviewed; it has been observed in cardiothoracic surgery. The management of the case is reported in detail and methods of detection and treatment are discussed.
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PMID:Chylothorax: a complication of Dwyer's anterior instrumentation. 86 72

The protrusion of cervical intervertebral discs was divided into three pathological entities by Spurling; soft disc, hard disc and spondylosis. We applied these concept to the dorsal intervertebral disc disease and treated two cases of thoracic spondylosis. Case 1. A 41-year-old male entered the hospital because of the gradual progression of weakness of both legs of two months' duration. Since ten days before admission he had not had an errection and had not been to able to walk and micturate. He also complained of paresthesia radiating down the abdomen into both legs. There were no visceral complaints. Neurological examination revealed severe weakness of both legs with bilateral impairment of deep sensations and hypalgesia up to the level of T6. Reflexes in both legs were hyperactive with sustained clonus. Plantar responses were extensor bilaterally. Though plain X-rays showed no changes, tomography revealed a calcified intervertebral spur formation at the T5-6 interspace. A myelogram showed a complete block of the contrast medium at the level of the upper part of T6. The patient underwent a complete laminectomy from T3 through T6 and extradural anterior decompression with the removal of the calcified disc at the T5-6 interspace using an air drill. Postoperatively, he demonstrated an immediate improvement in sensation and a gradual recovery in motor power. At his follow-up examination 14 months after surgery he could walk without assistance. Case 2. A 47-year-old dwarfish woman (130 cm) with a low back pain and difficulty in walking for a few years duration was admitted. A few months before admission she felt pain at her left lateral abdomen. There was weakness of both legs, greater in the left. Reflexes in her left lower extremity were hyperactive with sustained clonus. Plantar responces were flexor bilaterally. Palin X-rays showed scoliosis of thoracic spine with the top at T7 level and calcified intervertebral masses at T10-11, T11-12 and T12-L1, extending into the canal that were confirmed more clearly by tomography. Myelography by a cisternal puncture disclosed a complete block at the level of T10. The patient underwent total laminectomy of T9 through L2 and extradural anterior decompression with the removal of calcified discs. At her follow-up examination 12 months after surgery she could walk for herself with some residual neurological signs, minimal weakness in the right leg and hypesthesia up to the level of T12 in the left. We have discussed the incidental, related diagnostic and operative problems of this disease.
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PMID:[The protrusion of thoracic intervertebral disc-thoracic spondylosis (author's transl)]. 123 40

We studied the relationship of deterioration of cardiorespiratory function with respect to degree and localisation of apex of spinal curvature. The study comprised 33 patients (27 females and 6 males) aged 15 (11-21) years, surgically treated for an average scoliotic angle of 72 degrees (55-129 degrees, after Cobb) which was postoperatively reduced to 32.6 degrees (13-74 degrees). The static and dynamic cardiorespiratory function parameters were tested (pre-operatively and 24 months after surgery) by spirometry and plethysmography, arterial blood gas analysis, and the exercise tolerance test. In terms of the site and apex of the thoracic curve as determined by spine X-ray, patients were divided into two groups: upper thoracic scoliosis with the apex between T5 and T8 and lower thoracic scoliosis with the apex between T9 and T11. Only upper thoracic scoliosis with Cobb angle of more than 70 degrees correlated (r = -1) with restrictive ventilation disorder (vital capacity 68%) and latent hypoxaemia (uptake O2 ml/kg/min 63%) demonstrated during the exercise tolerance test (p > 0.05). The results of the test have demonstrated that surgically obtained 54% correction of the scoliotic curve improves pulmonary function (p < 0.05). However, the improvement does not match the degree of achieved scoliotic curve correction, what means that even in surgically treated high-angled thoracic scoliosis exists an increased risk of morbidity and mortality.
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PMID:Cardiorespiratory function in surgically treated thoracic scoliosis with respect to degree and apex of scoliotic curve. 828 32

A biomechanical study was performed in order to evaluate the initial stability of three spinal instrumentation systems, applied to a scoliosis model. Five calf spines (T11-L2) were destabilized anteriorly, and, by inserting a wedge-shaped resin disc within each destabilized intervertebral space, a thoracolumbar scoliosis was created. Three spinal instrumentation systems (Zielke anterior instrumentation, Kaneda anterior multisegmental fixation device, and Cotrel-Dubousset posterior instrumentation) were applied to correct the simulated scoliotic condition. Mechanical nondestructive cyclical testing in axial compression, rotation, flexion, and extension was performed on each spinal construct. The Kaneda device was the most stable instrumentation in all four loading conditions. Zielke instrumentation failed to restore the stability to the level of the intact spine in rotation, and was the least rigid instrumentation in flexion and extension. The Cotrel-Dubousset instrumentation demonstrated favorable stability in flexion and extension, but became the least rigid instrumentation in axial compression and rotation. This study suggests that a one-stage procedure with Zielke instrumentation and a two-stage procedure (anterior release with bone graft and posterior stabilization) with Cotrel-Dubousset instrumentation applied for the correction of scoliosis, should be supplemented with additional external or internal supports. The Kaneda device may offer enough stability with an anterior procedure alone in the correction of scoliosis.
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PMID:A biomechanical analysis of Zielke, Kaneda, and Cotrel-Dubousset instrumentations in thoracolumbar scoliosis. A calf spine model. 175 5

A three-year-old boy is reported who had congenital spastic paraparesis caused by severe segmental narrowing of the spinal cord. X-rays of the spine showed thoracolumbar scoliosis and anomalies of the thoracic vertebrae from T5 to T11. Myelography, with CT scanning, demonstrated severe narrowing of the T5 to T12 segments of the spinal cord, measuring only 1.5 mm at T10. This is believed to be the first report of this unusual anatomical finding in congenital spastic paraparesis. An early embryonic vascular insult is thought to be the most likely cause.
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PMID:Severe segmental narrowing of the spinal cord: an unusual finding in congenital spastic paraparesis. 280 48

This study is a retrospective review of 43 adult patients with idiopathic or congenital scoliosis who had spinal fusion from T11 or above to the sacrum. This study was prompted by the frustrations of the treating surgeons in attempting long fusions from the thoracic spine to the sacrum. Of 25 patients treated with a single-stage posterior fusion only 28% had a good result with a single procedure. Failures were due to pseudarthrosis, decompensation, or loss of lumbar lordosis. Ten patients treated with posterior fusion and subsequent 6-month augmentation had a 70% success rate. Eight patients treated with anterior followed by posterior fusion had a 75% success rate. The ideal answer to this clinical problem has not yet been found.
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PMID:Fusion to the sacrum for nonparalytic scoliosis in the adult. 302 99

The ambulatory status of 50 patients, aged 15 years and older, with spina bifida is assessed and related to the level of the lesion, the stability and presence of deformity at the hip joints, and the presence of pelvic obliquity and of scoliosis. A retrospective study was made of these variables for the year the child began walking and, when applicable, the year the child stopped walking. More than two-thirds of the group were community ambulators. Lesion review, and there were no household or nonfunctional ambulators. Lesion levels of the ambulators ranged from T11 to S2-S3, whereas lesion levels of the nonambulators ranged from T12 to L3-L4/L4. Most of the hips were not dislocated because the patients had undergone early surgery to restore muscle balance at the hip and, thus, to prevent dislocation. Some had undergone surgery to reduce hip dislocation, although it appears that such surgery is unnecessary for those with high lesions who use long calipers and whose hips require only flexion and extension ability in ambulation. Surgery resulted in significant limitation of flexion range at the hip in one instance only. Those ambulators with high lesions were compared with nonambulators, almost all of whom also had high lesions. The combination of hip flexion deformity, pelvic obliquity, and scoliosis is likely to preclude walking as is the presence of any one of these factors to a severe degree.
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PMID:Walking ability in mature patients with spina bifida. 634 83

The maximum range of motion between two adjacent vertebrae without soft tissues was measured from C1-C2 down to L5-S and factors such as rotation, lateral bending, extension, and flexion, during surface contact movement of the facet joints, were investigated. Thirty human cadaveric spines were studied. It was found that the individual spines had a characteristic level-dependent difference in the capacity for elementary motions at the facet joints. Those segments with restricted motion capacity were termed "spinal nodes". The human spine usually has three to four spinal nodes between the skull and the sacrum. They are C7-T1, T4-T5, T8-T9, and T11-T12. This intrinsic structural character of the human spine is expressed as "nodal motion structure". We postulate that this structure plays an important role in the formation of curve patterns in idiopathic scoliosis and other spinal deformities.
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PMID:Anatomical and biomechanical factors in the curve pattern formation of idiopathic scoliosis. 709 Jul 60

The erector spinae muscles of 20 normal humans were evaluated at C7, T3, T11, and L5 vertebral body levels bilaterally. At each level, the mean potential duration of the motor unit action potential was calculated. This control group was compared with a group of patients with C7 and L5 radiculopathy and with a group of patients with thoracic scoliosis. The mean potential durations of the radiculopathy group at the C7 and L5 levels were prolonged as were those values at the convex thoracic levels in the scoliotic group. Muscle biopsy of the erector spinae in the scoliotic group revealed grouped atrophy and changes consistent with a neuropathic process. A radiculopathic process was associated with idiopathic thoracic scoliosis and involved the convex side. It was maximal near the apex of the curve.
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PMID:Neuropathy in thoracic scoliosis. 743 84

It is well known that Boston bracing may stop progression in many patients with minor curves. One hundred and thirty-eight patients were treated with the Boston brace for idiopathic scoliosis. Age was 14.1 +/- 1.6 years at the time of bracing, and the length of time spent in the brace was 2.6 +/- 1.0 years. The major curve at the time of bracing was 39 +/- 10 degrees, and 36 +/- 11 degrees at the time of follow-up in the patients who completed bracing. Thirty-six patients progressed, and were later fused. None of the patients with the apex of the curve between T11 and L1 required spinal fusion (p < 0.0001). No patients with curve magnitude on sidebending of less than 11 degrees needed spinal fusion. None of the patients who had a Harrington factor of less than five degrees per vertebra needed spinal fusion.
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PMID:[Idiopathic scolioses treated with the Boston brace]. 832 46


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