1/16. superior mesenteric artery syndrome after segmental instrumentation: a biomechanical analysis.Superior mesenteric artery (SMA) syndrome is a rare complication that occurs after correction of scoliosis. A review of the literature suggests that the incidence of this syndrome may be decreasing, as methods for the correction of scoliosis have improved. We present the first report of SMA syndrome that occurred after segmental 'derotational' instrumentation. Computerized axial tomography was helpful in suggesting the diagnosis of this condition. The risk factors and pathophysiology of SMA syndrome are reviewed with respect to the biomechanical effects of casting and Harrington and segmental instrumentation systems on the spine. attention to the three-dimensional nature of the scoliotic deformity, particularly in the sagittal plane, may help to predict those at risk for the development of this potentially fatal syndrome.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/16. Intra-rachidian disorders: two unusual cases of recurrent abdominal pain in children.Recurrent abdominal pain (RAP) is generally thought to be of psychological origin but organic aetiologies are increasingly being identified. The cases of two children with vertebral disorders revealed by recurrent abdominal pain are reported. A 14-y-old girl presented with RAP associated with scoliosis, due to a T8-T9 intra-dural extra-medullary tumour. A 7-y-old girl who suffered from nocturnal RAP located in the right iliac fossa for 1 y had decreased muscular strength, pyramidal signs, and a 10 degree Lassegue sign in the right lower limb, revealing a vascular malformation extending from T12 to L2. Conclusion: Atypical pain and associated neurological signs or scoliosis must raise the possibility of intra-rachidian disorders. Magnetic resonance examination will then precisely state the location and nature of the pathological process, avoiding excessive delay in therapeutic management.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/16. Anterior single-rod instrumentation of the thoracic and lumbar spine: saving levels.STUDY DESIGN: To evaluate the ability of single-rod anterior instrumentation to save or preserve fusion levels and improve thoracic hypokyphosis in patients with adolescent idiopathic thoracic, thoracolumbar, or lumbar scoliosis. OBJECTIVE: To provide indications for single anterior rod instrumentation for the treatment of adolescent idiopathic scoliosis and demonstrate effectiveness in properly selected cases. SUMMARY OF BACKGROUND DATA: Posterior multisegmented dual rod instrumentation is the most commonly used instrumentation for the surgical treatment of adolescent idiopathic scoliosis. The issue of longer fusion levels and inability to correct hypokyphosis with posterior instrumentation continues to be debated in the literature. Anterior instrumentation has the ability in certain curve patterns to preserve distal and proximal levels as well as correct thoracic hypokyphosis. methods: A brief discussion of the Lenke adolescent idiopathic scoliosis classification system is presented. Surgical treatment options for each of the curve types are discussed in detail. RESULTS: Single-rod anterior instrumentation for adolescent idiopathic scoliosis will predictably save levels in Type I curves without hyperkyphosis as well as Type 5 curves; however, it is usually contraindicated in Type 2, Type 4, and Type 6 curves. Single-rod anterior instrumentation can occasionally be utilized in Type 3 curves if the magnitude of the lumbar curve is significantly less than the thoracic curve and the flexibility of the lumbar curve approaches 25 degrees on the side-bending radiograph. CONCLUSIONS: Single-rod anterior instrumentation will often saved one to three distal fusion levels when treating isolated major thoracic, thoracolumbar, or lumbar curves. Fusion levels should include upper to lower Cobb levels. Additionally, anterior single-rod instrumentation because its kyphogenic nature will predictably correct hypokyphosis of the thoracic spine.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/16. A case report of severe kyphoscoliosis and autofusion of the posterior elements in two siblings with central core disease.STUDY DESIGN: A case report of two siblings (ages 14 and 17 years) with central core disease and prior malignant hyperthermia successfully treated with spinal fusion surgery for severe kyphoscoliosis. OBJECTIVES: Our objectives were as follows: to describe the previously unreported findings of posterior element autofusion and ligamentum flavum ossification; to increase surgeon awareness to the nature of this condition and associated findings; and to prepare the surgeons for the possibility of autofusion and the required surgical modifications, including extensive osteotomies at the time of spinal fusion surgery to achieve correction based on these findings. SUMMARY OF BACKGROUND DATA: Central core disease is a rare congenital myopathy with a reported association with kyphoscoliosis. Spinal deformity of this severity in central core disease has not previously been reported in the literature. methods: Two siblings with central core disease, history of malignant hyperthermia, and severe kyphosing scoliosis (187 degrees and 108 degrees) underwent correction of deformity and spinal fusion surgery. The clinical, operative, and radiographic features are detailed. RESULTS: The spinal deformities associated with central core disease in these 2 cases were severe. The posterior elements underwent autofusion necessitating alteration in surgical technique to correct the deformity. Despite the risks of malignant hyperthermia and the difficulty of surgical correction, good clinical improvements can be achieved even in cases of severe deformity. CONCLUSIONS: A diagnosis of central core disease must be considered in patients presenting with severe spinal deformity and myopathic symptoms. This spinal deformity may be progressive and become severe. Surgical intervention in these cases may be complicated by posterior element autofusion necessitating alteration in surgical technique to correct the deformity. Despite the risk of malignant hyperthermia, surgery may be performed safely.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/16. Neurofibromatosis type I with severe dystrophic kyphoscoliosis and its operative management via a simultaneous anterior-posterior approach: a case report and review of the literature.BACKGROUND CONTEXT: Neurofibromatosis is an autosomal-dominant hereditary disorder with two subtypes: NF-1 (type I) and NF-2 (type II). NF-1 is a complex disorder with a constellation of manifestations that can also entail skeletal abnormalities, including spinal deformity of a noncongenital nature with early age onset. The short, sharp, angular curve usually present in the thoracic region, as exhibited in NF-1, presents a quandary in its surgical management. Various studies have reported on the efficacy of anterior correction as opposed to posterior alone, whereas others have advocated a sequential, combined approach to diminish the degree of deformity and achieve solid arthrodesis. However, despite solid arthrodesis, curve progression may still ensue. Nonetheless, a simultaneous anterior-posterior approach to treat such a condition of NF-1 with severe dystrophic kyphoscoliosis is a rare occurrence. PURPOSE: To describe the presentation and operative management of a patient with NF-1 and severe dystrophic kyphoscoliosis. STUDY DESIGN: A case report and review of the literature. methods: A clinical and radiographic review of a 51-year-old male patient who presented with NF-1, a 165-degree thoracic kyphotic deformity, associated scoliosis, varied degree of vertebral destruction of T9-T11, and paraparesis below T10. RESULTS: Operative intervention of the deformity consisted of a simultaneous anterior-posterior approach and entailed posterior cord exposure, anterior vertebrectomy of T9-T11, cord decompression, posterior osteotomy (posterior elements were auto-fused), anterior distraction and kyphosis correction, anterior strut grafting, anterior rod instrumentation, and posterior compression instrumentation and fusion from T6-L2. The deformity was reduced, sold fusion was noted, and the patient was asymptomatic. CONCLUSIONS: A simultaneous anterior-posterior approach for the surgical treatment of severe dystrophic kyphoscoliosis in neurofibromatosis type I is an avenue to properly visualize the spinal cord, achieve solid arthrodesis, and to minimize as well as prevent the progression of deformity.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/16. scoliosis in association with infantile hypophosphatasia: a case study in two siblings.STUDY DESIGN: A case study of scoliosis in two siblings with infantile hypophosphatasia and review of literature are presented. OBJECTIVES: To report the rare occurrence of scoliosis in two siblings with infantile hypophosphatasia and detail problems in the surgical management of scoliosis in this rare disease. SUMMARY OF BACKGROUND DATA: To the authors' knowledge there is only one reported case of scoliosis in infantile hypophosphatasia. However, there is no report describing the nature of the curve, its progression, or the surgical management of scoliosis in infantile hypophosphatasia. methods: The first sibling was diagnosed shortly after birth to have scoliosis that progressed rapidly despite brace treatment. At 4 years, he underwent anterior convex arthrodesis and posterior T6-L1 Luque trolley stabilization. Because of further curve progression, he had to undergo corrective anterior and posterior osteotomies, stabilization, and fusion at 11 years of age. The second sibling was diagnosed to have scoliosis at the age of 3 years and underwent anterior thoracoscopic release and posterior Luque trolley stabilization. RESULTS: The first sibling with a mild form of infantile hypophosphatasia had to undergo multiple procedures to attain fusion and arrest of curve progression. The second sibling with a severe variety of infantile hypophosphatasia surprisingly attained a spontaneous fusion of the curve following the initial correction and stabilization with no further progression at 9-year follow-up. CONCLUSIONS: Curve progression and fusion rates following scoliosis correction are not related to the disease severity or biochemical findings. These rapidly progressive curves are amenable to surgical correction despite the unfavorable metabolic nature of the disease. hypercalcemia and seizures responding to pyridoxine are complications in the postoperative period of which the surgeon should be aware.- - - - - - - - - - ranking = 2keywords = nature (Clic here for more details about this article) |
7/16. Complete L1-L2 lateral dislocation without fracture and neurologic deficit in a child.spinal injuries in the infantile age group are relatively rare, mainly due to anatomical and biomechanical features of the pediatric spine. With its hypermobile character, pediatric spine can withstand trauma without fracture, and the elastic nature of the young spine allows easy slippage between segments, especially under the age of 8. Clinically, a few of the cases present with subluxation only, which seldom involve the lumbar level. We report an extremely rare case of traumatic complete upper lumbar lateral lystesis in a 3-year-old boy. The patient was treated conservatively and followed up for 2 years with some degree of correction.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/16. Acute airway obstruction, hypertension and kyphoscoliosis.An elderly woman developed acute respiratory obstruction after choking on a bolus of food. On rigid bronchoscopy no foreign body, or anatomical obstruction was seen, but airway obstruction recurred during emergence from general anaesthesia, and was thought to be functional in nature. A recurring airway obstruction followed, relieved by induction of anaesthesia and by sedation. This was subsequently demonstrated to be caused by a tortuous aorta which impinged intermittently on the anterior tracheal wall, as a result of kyphoscoliosis of the thoracic spine. We attribute the relief of airway obstruction by general anaesthesia to a reduction in arterial blood pressure.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
9/16. Dumb-bell ganglioneuroma of the spine misinterpreted as progressive idiopathic scoliosis. Case report.A giant ganglioneuroma generating a progressive scoliosis in a 16-year-old girl is presented. The interval between the start of the orthopaedic treatment and the diagnosis of the true nature of the disease was more than 4 years, thus allowing the development of a giant partly intracanalicularly partly retroperitonealy expanding tumor mass. The report emphasizes and describes the combined neurosurgical, general surgical and orthopaedic surgical treatment and presents the results of light- and electron microsopical, immunohistochemical and quantitative neurochemical investigations of the resected tumor.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
10/16. Degenerative adult onset scoliosis.There are people who have no history of scoliosis who develop spinal deformity of a progressive nature as adults, associated with severe degenerative disc disease. The clinical syndrome associated with this deformity is not well documented. In an attempt to describe this clinical syndrome more precisely, 21 patients with the diagnosis of degenerative scoliosis were identified and reviewed. review included history with pain drawings when available, physical examination, bone densities, and standing spinal roentgenograms. patients with spinal compression fractures, spondylolyses, prior history of scoliosis or radiographic findings consistent with an idiopathic scoliosis were excluded. Our review shows that these patients can develop, along with progressive scoliosis, loss of lumbar lordosis with a resulting flat back deformity. These patients commonly present in the sixth decade with a predominantly stenotic symptom complex, but often lack the classic feature of relief in a sitting posture. The number of male and female patients was approximately equal. Roentgenogram findings show a high angle deformity over a short number of spinal segments and an absence of bony features associated with idiopathic scoliosis such as lateral vertebral wedging and alterations of the lamina. The incidence of this condition remains to be established.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
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