1/9. Deep wound infections after neuromuscular scoliosis surgery: a multicenter study of risk factors and treatment outcomes.STUDY DESIGN: A retrospective case-control study evaluating risk factors for infection, causative organisms, and results of treatment in patients with cerebral palsy or myelomeningocele who underwent fusion for scoliosis was performed. OBJECTIVES: To identify risk factors for infection, and to characterize the infections in terms of infecting organisms and response to treatment. SUMMARY OF BACKGROUND DATA: No previous studies have analyzed risk factors or causative organisms, nor have they indicated results of treatment for infections in this group of patients. methods: After a 10-year retrospective review of 210 surgically treated patients, deep wound infections developed in 16 patients with myelomeningocele and 9 patients with cerebral palsy. These patients were studied extensively for possible risk factors, along with 50 uninfected patients matched for age, diagnosis, and year of surgery. Statistical testing was performed to identify risk factors. The courses of the infections were characterized in terms of organisms isolated and response to treatment. Treatment was performed in a stepwise fashion and classified in terms of the most successful step: debridement and closure, granulation over rods, or instrumentation removal. RESULTS: Of the 10 risk factors tested, 2 were found to be significant: degree of cognitive impairment and use of allograft. Findings showed that 52% of the infections were polymicrobial. Gram-negative organisms were isolated as commonly as gram-positive organisms. The most common organisms were coagulase-negative staphylococcus, enterobacter, enterococcus, and escherichia coli.- debridement and closure were successful in 11 of 25 patients with deep wound infection. Of the 14 patients with infection not resolved by serial debridements and closure, 2 were managed successfully by allowing the wound to granulate over rods, and 7 required rod removal for persistent wound drainage. There were three symptomatic pseudarthroses. Infections resulting from gram-positive organisms were most often managed successfully with debridement and closure (P = 0.012). CONCLUSIONS: patients with cerebral palsy or myelomeningocele who have severe cognitive impairment, and those who received allograft may be at increased risk for infection. Infections are more often polymicrobial and caused by gram-negative organisms than is typical for elective orthopedic procedures. This suggests an enteric source. Treatment with debridement and closure was not always successful. patients in whom infection develops are then at increased risk for pseudarthrosis.- - - - - - - - - - ranking = 1keywords = myelomeningocele (Clic here for more details about this article) |
2/9. Evaluating congenital spine deformities for intraspinal anomalies with magnetic resonance imaging.SUMMARY: The incidence of intraspinal abnormalities associated with congenital spinal anomalies as detected by magnetic resonance imaging (MRI) is becoming better defined. In this study, 41 nonrandomized children with congenital spinal deformities (excluding myelomeningocele) who underwent complete MR evaluation were reviewed. Of the 41 congenital spinal deformities, 37 demonstrated congenital scoliosis, with failure of formation in 19, failure of segmentation in 4, and mixed defects in 14. The remaining four deformities were cases of congenital kyphosis. Thirteen patients with congenital spine anomalies were noted to have intraspinal abnormalities identified by MRI: tethered cord in 12 patients, syringomyelia in 3 patients, and diastematomyelia in 5 patients. Of the 12 patients with tethered cord, 2 patients had neurologic deficits. Urorectal anomaly was one of the most common associated findings (15%). Considering an incidence of intraspinal anomalies of 31% and as clinical manifestations may not be initially detectable, MRI is recommended in patients with congenital spinal deformity as part of the initial evaluation even in the absence of clinical findings.- - - - - - - - - - ranking = 0.33333333333333keywords = myelomeningocele (Clic here for more details about this article) |
3/9. Anterior thoracic myelomeningocele presenting as a retromediastinal mass. Case report.Myelomeningocele presenting as a retromediastinal mass originating from the midline defect through the fused T-4, T-5, and T-6 VBs is described. An 11-year-old boy with a completely normal systemic and neurological examination suffering pulmonary problems such as effort dyspnea and severe kyphosis was evaluated and an anterior thoracic myelomeningocele was diagnosed. The boy underwent surgery for excision of the meningomyelocele sac and correction of kyphoscoliosis. His year-long follow-up period as an outpatient was uneventful. A comprehensive pubmed search of the literature returned no results for an "anterior thoracic myelomeningocele" query. To the best of the authors' knowledge, this is the only case described in the literature.- - - - - - - - - - ranking = 2keywords = myelomeningocele (Clic here for more details about this article) |
4/9. Selective posterior rhizotomy for treatment of progressive spasticity in patients with myelomeningocele. Preliminary report.This preliminary report describes two cases of progressive spasticity and scoliosis in children with myelomeningocele. Both patients had evidence of tethered spinal cord. Untethering of the spinal cord was successful in arresting the scoliosis but not the spasticity. Selective posterior rhizotomy was successful in resolving the spasticity in both cases. The technique of selective posterior rhizotomy is reviewed.- - - - - - - - - - ranking = 1.6666666666667keywords = myelomeningocele (Clic here for more details about this article) |
5/9. Cranial nerve injury from halo traction.Six of the 70 patients treated with skeletal traction at the Alfred I. duPont Institute exhibited cranial nerve complications. The sixth cranial nerve was most commonly affected by distraction and resulted in weakness in lateral gaze. A combined lesion of the ninth, tenth and twelfth nerves was not an infrequent complication and presented as abnormalities in swallowing, quality of speech, and of tongue movement. It has not been singled out for its significance in the literature but it is potentially the most lethal of the complications. From our review it appears that patients who have had radiation treatment and who have presented with myelomeningocele experience a higher risk of complication in cranial skeletal traction. A definite clinical-pathological correlation could not be made. Frequent monitoring of the patients in skeletal traction is necessary, and prompt recognition of the clinical signs of these complications must be stressed. The complications in the patients of our series subsided upon release of the distraction force.- - - - - - - - - - ranking = 0.33333333333333keywords = myelomeningocele (Clic here for more details about this article) |
6/9. Congenital cervical scoliosis with unilateral congenital nerve deficit in the upper extremity. Report of two cases.Two patients are reviewed, each having an unusual clinical syndrome of progressive congenital cervical scoliosis and unilateral arm paralysis. This appears to be a unilateral developmental defect in both mesenchymal and neural tissue. There was a unilateral spina bifida without myelomeningocele, meningocele, or lipoma. The cervical spine deformity was progressive at a young age, one patient having been fused at age 2 years, the other at age 5 years. At surgery, the dura was intact but unprotected on the concavity of the curve. Bridging bone grafts were utilized to span the defects. The arm paralysis was extensive in both patients, but improvement in function was accomplished by appropriate reconstructive procedures.- - - - - - - - - - ranking = 0.33333333333333keywords = myelomeningocele (Clic here for more details about this article) |
7/9. Hemodynamic instability of myelomeningocele patients during anterior spinal surgery.Surgery for spinal fusion for patients with myelomeningocele is accompanied by a high rate of complications. The authors report six cases of sudden intra-operative hemodynamic instability which occurred during anterior spinal fusion; the procedures had to be aborted. All children were successfully resuscitated and four patients subsequently underwent successful anterior and posterior spinal fusion. Four of the children had positive skin and serum allergy tests to latex.- - - - - - - - - - ranking = 1.6666666666667keywords = myelomeningocele (Clic here for more details about this article) |
8/9. latex anaphylaxis during spinal surgery in children with myelomeningocele.Intra-operative anaphylaxis to latex involves cutaneous, respiratory and circulatory changes which may prove fatal if not promptly recognized and treated. It is estimated that 18 to 40 per cent of children with spina bifida may be affected by latex allergy. Current tests available lack sufficient sensitivity and specificity to be recommended as routine screening measures, therefore any allergic history in children with myelomeningocele should alert the clinician to the possibility that severe anaphylactic reactions may occur, especially when large mucosal and pleural-peritoneal surfaces are exposed, as noted in the four reported cases. epinephrine is the drug of choice should a Type 1 reaction occur.- - - - - - - - - - ranking = 1.6666666666667keywords = myelomeningocele (Clic here for more details about this article) |
9/9. Lumbar spine duplication presenting as adolescent scoliosis. A case report.STUDY DESIGN: A report of a case of lumbar spine duplication with the clinical appearance of adolescent scoliosis. OBJECTIVE: To increase knowledge about the pathogenesis and treatment of lumbar spinal duplication. SUMMARY OF BACKGROUND DATA: Although there have been other reports of lumbar spine duplication of this magnitude, these malformations typically are associated with severe neurologic abnormalities (dicephalus, myelomeningocele) or gastrointestinal abnormalities (omphalocele, neurenteric fistulas). Several investigators have recommended early surgical intervention for this abnormality because of the perceived risk of progressive neurologic abnormality from tethering of the cord. methods: In a 13-year-old girl who had truncal asymmetry, lumbar spine duplication was noted on plain radiographs. A magnetic resonance study was obtained, and the patient was observed with conservative treatment for 3 years. RESULTS: Although extensive abnormalities were noted on the magnetic resonance images, which were related to duplication of spinal cord and vertebral bodies, the patient was neurologically intact and remained so until skeletal maturity. CONCLUSIONS: This rare malformation typically has severe neurologic sequelae. Conservative management in the reported patient did not result in a progressive neurologic lesion at the time of skeletal maturity.- - - - - - - - - - ranking = 0.33333333333333keywords = myelomeningocele (Clic here for more details about this article) |