1/206. Ischio-spinal dysostosis: a previously unrecognised combination of malformations.BACKGROUND: Ischial hypoplasia is an extremely rare malformation, both as an isolated anomaly and as a syndromic constituent. OBJECTIVE: To elucidate the clinical and radiological characteristics in five patients with the combination of ischial hypoplasia and spinal malformations. MATERIALS AND methods: The clinical records and radiographs of two females and three males, ranging in age from 3 months to 38 years, were evaluated. RESULTS: Ossification defects of the ischial rami were symmetrical and total in four patients, whereas the right ischial ramus was partly ossified in the other patient. All patients possessed multiple segmental defects of the spine, with rib anomalies of varying severity. One patient characteristically showed multiple rib gaps, resulting in respiratory distress. Severe anomalies of the cervical spine were evident in two patients. Four patients exhibited lumbosacral hypoplasia, which ultimately led to cauda equina syndrome in three older patients. One patient had mild facial dysmorphism and another had a diversity of anomalies, including ichthyosiform skin changes. Four patients were sporadic cases, whereas the other patient was born to consanguineous parents. CONCLUSIONS: The combination of anomalies in these patients constitutes a recognisable pattern of malformations but may represent a heterogeneous group of disorders.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
2/206. Neurological complications of anterior spinal surgery for kyphosis with normal somatosensory evoked potentials (SEPs).We report a case of neurological complications of anterior release for correction of kyphosis. After the operation, the patient had pyramidal weakness and decreased pain sensation below T5, whereas light touch, proprioception and vibration sensation were intact. Clinical and neurophysiological findings in this patient suggested a partial lesion of the spinal cord probably due to ischaemia in the territory of the anterior spinal artery. Intraoperative and postoperative tibial nerve SEPs remained normal, which stresses the need for recording from the motor pathways.- - - - - - - - - - ranking = 1.2keywords = spinal (Clic here for more details about this article) |
3/206. The importance of an intact abdominal musculature mechanism in maintaining spinal sagittal balance. Case illustration in prune-belly syndrome.STUDY DESIGN: A rare case of thoracic hypokyphotic deformity secondary to prune-belly syndrome is presented. OBJECTIVES: To discuss the role of an intact abdominal musculature mechanism in maintaining spinal sagittal balance, and to present a case illustration of prune-belly syndrome. SUMMARY OF BACKGROUND DATA: There has been an ongoing debate concerning the integrity of the abdominal musculature unit in maintaining spinal support and stability. It is now believed that intra-abdominal pressure hitherto generated plays an important role in the stabilization of the spine. Congenital aplasia of the abdominal musculature, termed prune-belly syndrome, might therefore result in the loss of spinal function and stability. The literature also is reviewed for the incidence of spinal deformities related to this condition. methods: A unique case of prune-belly syndrome in a 33-year-old man with congenital aplasia of the abdominal musculature is presented. RESULTS: The patient exhibited loss of the spinal sagittal balance, with resultant development of a thoracic hypokyphotic deformity and thoracolumbar scoliosis. CONCLUSIONS: scoliosis appears to be the most commonly reported spinal deformity. Unequal compressive forces on the vertebral endplates may be the proposed mechanism for the spinal deformities. Compensatory lumbar paraspinal overactivity resulting from the inability to generate normal intra-abdominal pressures because of a deficient abdominal wall musculature mechanism seems to be the plausible explanation for the observed thoracic hypokyphatic deformity.- - - - - - - - - - ranking = 2.4keywords = spinal (Clic here for more details about this article) |
4/206. The halo-Milwaukee brace. Case series of a revived technique.STUDY DESIGN: A case series in which the halo-Milwaukee brace was used for postoperative immobilization in children with complex congenital and developmental spinal deformities. OBJECTIVES: To describe the use of halo-Milwaukee orthosis in a pediatric population for stabilization of the cervical and upper thoracic spine. SUMMARY AND BACKGROUND DATA: Postoperative immobilization of the neck and upper thorax can be achieved with cervical orthoses, cervicothoracic lumbar orthosis, halo cast, Minerva jacket, or halo vest. In the young child or in individuals with severe deformities, prefabricated braces often do not provide adequate stability or predictable fit. The halo-Milwaukee brace has proven to be an effective and versatile technique in the management of complex pediatric spinal deformities. methods: Halo-Milwaukee brace immobilization was used in 12 patients after surgical stabilization of the upper thoracic or cervical spine. Technique and indications are discussed in this report. Surgical outcomes and complications were reviewed retrospectively in all cases. RESULTS: Application of the halo-Milwaukee brace was a clinically effective and safe means of controlling the upper thoracic and cervical spine. The orthosis was well tolerated and allowed access to the posterior incision. The brace is easily converted to a standard Milwaukee brace with neck ring. The pelvic segment of the brace is molded before surgery, and in most instances did not require postoperative modification. CONCLUSION: The halo-Milwaukee brace is a simple and convenient method of intraoperative and postoperative immobilization. The technique is applicable in patients who cannot be treated with more conventional off-the-shelf orthoses. The brace was well tolerated and allowed for early patient mobilization.- - - - - - - - - - ranking = 0.4keywords = spinal (Clic here for more details about this article) |
5/206. Hepatic ischemia as a complication after correction of post-traumatic gibbus at the thoracolumbar junction.STUDY DESIGN: This is a case report of hepatic ischemia secondary to celiac trunk stenosis as a complication after correction of a preoperative 30 degrees gibbus at the thoracolumbar junction. OBJECTIVES: A high index of suspicion is needed to make a timely diagnosis of hepatic ischemia in any setting. After spinal reconstruction involving lengthening, symptoms suggestive of an acute abdomen accompanied by markedly elevated liver enzymes should be evaluated with an angiogram to check for celiac trunk stenosis. SUMMARY OF BACKGROUND DATA: review of the literature showed no reported cases of hepatic ischemia or descriptions of the status of celiac trunk stenosis after spinal surgery. Even in more commonly associated settings, diagnosis of both phenomena is often delayed, with possible morbid consequences. methods: A case is presented of a patient who underwent gibbus correction and re-establishment of lost anterior intervertebral distance at the thoracolumbar junction. After surgery, ischemic hepatitis, a perforated gallbladder, and splenic infarction developed secondary to celiac trunk stenosis-a result of cephalad displacement of the celiac trunk and compression of the artery by the diaphragmatic ligament. RESULTS: An emergent exploratory laparotomy with cholecystectomy was performed followed by an angiogram, which demonstrated stenosis of the celiac trunk. After release of the arcuate ligament, the patient's condition improved rapidly, and he made a complete recovery. CONCLUSIONS: The consequences of a delay in diagnosis of hepatic ischemia can be disastrous. An awareness of the possibility of this complication after spinal lengthening should facilitate a timely angiogram and operative intervention.- - - - - - - - - - ranking = 0.6keywords = spinal (Clic here for more details about this article) |
6/206. Progressive rotational dislocation in kyphoscoliotic deformities: presentation and treatment.STUDY DESIGN: Progressive rotational dislocation of the spine has been described as the most serious evolutive risk of kyphoscoliosis. A retrospective chart review was conducted on 11 patients with this deformity. OBJECTIVES: To delineate the clinical and radiologic characteristics of this entity to facilitate early diagnosis and treatment. The outcome after treatment was analyzed to point out the rationale for appropriate treatment. methods: The characteristic radiologic feature was a short sharp angled kyphosis (average 112) at the junction of two lordoscoliotic curvatures. The etiology of the spinal deformity was neurofibromatosis in four patients and various dysplastic conditions in seven patients. Two patients had congenital vertebral defects. Structural weakness of the bone was therefore a basic feature. Neurologic impairment was identified in three patients (one complete, two incomplete). Four patients had a nonunion after a previous attempt at spinal fusion: two after a combined anterior and posterior fusion with an anterior approach from the convexity and two after a posterior fusion alone. All patients underwent complete circumferential stabilization through anterior strut-grafting and posterior fusion. An anterior approach from the concavity was performed systematically with tibial strut grafts inserted in a palisade fashion. Preoperative correction of the deformity was performed by progressive controlled elongation in a Stagnara elongation cast. Cotrel-Dubousset instrumentation was used in two patients, Harrington instrumentation was used in two patients, and cast immobilization alone was used in seven patients. RESULTS: The average follow-up period was 5 years 5 months. All but one patient achieved successful spinal fusion. Loss of correction at the latest follow-up evaluation was less than 3 degrees in nine patients. The two patients with incomplete neurologic deficits were improved, but the patient with the complete deficit remained unchanged after surgery. CONCLUSIONS: awareness of the possibility of a progressive rotational dislocation in dystrophic forms of kyphoscoliosis should allow for an early diagnosis and stabilization. The percentage of patients having a neurologic deficit in this series was significantly less important than in the initial report. Early anterior strut grafting from the concavity of the scoliotic curvature and posterior fusion is recommended.- - - - - - - - - - ranking = 0.6keywords = spinal (Clic here for more details about this article) |
7/206. Case study: acceleration/deceleration injury with angular kyphosis.OBJECTIVE: To discuss the case of a patient who received upper cervical chiropractic care after trauma-induced arcual kyphosis in the cervical spine. A practical application of conservative management for posttrauma cervical spine injury in the private office setting is described. Clinical Features: A 17-year-old female patient suffered an unstable C3/C4 motor segment after a lateral-impact motor vehicle collision. Additional symptoms on presentation included vertigo, tinnitus, neck and shoulder pain, and confusion. Intervention and Outcome: Conservative management consisted exclusively of upper cervical-specific adjustments guided by radiographic analysis and paraspinal bilateral skin temperature differential analysis of the cervical spine. During 10 weeks of care and 22 office visits, all symptoms subsided and the instability of C3/C4 motor segment appeared to be completely resolved. CONCLUSION: This study provides support for the use of upper cervical chiropractic management in cervical spine trauma cases. The clinical work-up consisted of physical examination, radiographic analysis, computer-administered and scored cognitive function testing, and audiometric examination. After conservative care, these examinations were repeated and demonstrated that the objective findings concurred with the subjective improvements reported by the patient.- - - - - - - - - - ranking = 0.2keywords = spinal (Clic here for more details about this article) |
8/206. Surgical management of spinal involvement in children and adolescents with Gaucher's disease.Gaucher's disease is an uncommon hereditary glycolipid storage disorder characterized by the accumulation of glucocerebroside in the lysosomes of macrophages of the reticuloendothelial system. Skeletal manifestations are variable in severity and typically involve the long bones. Vertebral involvement is less well characterized, particularly in children and adolescents. We report on the surgical management of spinal involvement in four children and adolescents with Gaucher's disease; two for kyphotic deformity and two for kyphotic deformity associated with neurologic compromise. We recommend anterior spinal release with fusion and posterior spinal fusion with segmental instrumentation in cases of kyphotic deformity. In cases of spinal cord compromise at the apex of the kyphotic deformity with retropulsion of involved bone, anterior decompression also should be performed. Routine surveillance for spinal deformity in patients with Gaucher's disease is necessary to allow early intervention before the development of severe deformity and neurologic compromise.- - - - - - - - - - ranking = 1.8keywords = spinal (Clic here for more details about this article) |
9/206. Multicore myopathy: respiratory failure and paraspinal muscle contractures are important complications.Three ambulant males with multicore myopathy, a rare congenital myopathy, are reported with nocturnal hypoventilation progressing to respiratory failure at the age of 9, 13, and 21 years. Deterioration in these individuals occurred over several months without any precipitating event. patients had clinical evidence of nocturnal hypoventilation with hypoxaemia and hypercapnia. Forced vital capacity was significantly reduced (20 to 43% of predicted level). These parameters improved on institution of overnight ventilation using a BiPAP pressure support ventilator with face mask or nasal pillows with O2 saturation maintained above 90% overnight and an increase in forced vital capacity by as much as 100% (0.3 to 0.6 litres). This was matched by a symptomatic and functional improvement. Also present in these patients and not previously reported is the association of multicore myopathy with paraspinal contractures which produce a characteristic scoliosis described as a 'side-sliding' spine. This may be improved by spinal bracing or surgery.- - - - - - - - - - ranking = 1.2keywords = spinal (Clic here for more details about this article) |
10/206. "Bamboo spine" starts to bend--something is wrong.A typical complication of ankylosing spondylitis with an atypical patient history is reported and the topic is discussed. The diagnosis of a spinal fracture may be difficult in a "bamboo spine".- - - - - - - - - - ranking = 0.2keywords = spinal (Clic here for more details about this article) |
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