RESUMEN
PURPOSE: Previous work has suggested that surface topography can be used for repeated measurements of deformity during curve monitoring following an initial radiograph. Changes in deformity during natural curve progression may be subtle. An important preemptive question to answer is whether topography can follow a large change in spine deformity, as in scoliosis correction. We assess the ability of surface topography to track the evolution of spine deformity during anterior scoliosis correction relative to traditional radiographs. Anterior scoliosis correction was chosen for this analysis because it changes the shape of the trunk without leaving a surgical scar and muscle atrophy along the posterior spine. METHODS: Following IRB approval, 18 patients aged 14.6 ± 2.0 years at surgery were enrolled in a retrospective review of coronal radiographs and topographic scans acquired before and after scoliosis correction. Radiographic and topographic measures for the coronal curve angle before and after surgery were compared. RESULTS: Surface topography estimates correlate with radiographic measures of the pre- (r = 0.7890, CI = [0.4989 0.9201], p < 0.00001), postsurgical (r = 0.7485, CI = [0.4329 0.9006], p = 0.0004), and the change in the coronal curve angle (r = 0.6744, CI = [0.3028 0.8680], p = 0.0021) due to surgery. CONCLUSIONS: We provide evidence open for further extension that topography can follow changes in the coronal curve angle comparably to radiographs. LEVEL OF EVIDENCE: Level IV.
Asunto(s)
Escoliosis , Fusión Vertebral , Humanos , Estudios Retrospectivos , Escoliosis/diagnóstico por imagen , Escoliosis/cirugía , Vértebras Torácicas , Resultado del TratamientoRESUMEN
STUDY DESIGN: Case report (review of patient records, imaging, and pulmonary function tests) and literature review. OBJECTIVES: To describe the case of a skeletally immature patient with Marfan syndrome who underwent anterior scoliosis correction (ASC) and muscle-sparing posterior far lateral interbody fusion (FLIF) in a two-stage procedure to correct progressive severe double major scoliosis and spondylolisthesis. Patients with Marfan syndrome suffer from rapidly progressive scoliosis and spondylolisthesis. Operative treatment has typically been limited to PSF, but newer techniques may be less invasive and provide more spine motion. METHODS: A 12-year-old girl with Marfan syndrome, spondylolisthesis, and severe progressive scoliosis underwent a two-stage procedure to achieve correction. Muscle-sparing posterior FLIF of the spondylolisthesis from L4-S1 was initially performed, followed 1 week later by ASC from right T4-T11 and left T11-L3 using an anterior screw/cord construct. RESULTS: Follow-up from the index procedures for the spondylolisthesis and scoliosis is 35 months. No significant complications occurred in perioperative and postoperative follow-up periods. At the 13-month follow-up, the double major scoliosis showed continued curve correction via growth modulation and overcorrection of the lumbar to - 13°. A revision lengthening procedure of the anterior cord from T11-L3 was performed. An asymptomatic elevated hemidiaphragm was discovered at 6 weeks postoperation, which was believed to be secondary to retraction neuropraxia and subsequently improved. At 21 months postlengthening and 35 months postindex procedure, she is skeletally mature and the curves have maintained correction in both the coronal and sagittal planes without any further complications. CONCLUSIONS: Anterior scoliosis correction of both a thoracic and lumbar curve combined with an L4-S1 PSF was effective for this patient and may be promising for patients with Marfan syndrome, progressive scoliosis, and spondylolisthesis. Overcorrection can be planned for and easily corrected by inserting a new cord of a different length.
Asunto(s)
Síndrome de Marfan/cirugía , Escoliosis/cirugía , Fusión Vertebral/métodos , Espondilolistesis/cirugía , Niño , Progresión de la Enfermedad , Femenino , Humanos , Región Lumbosacra , Tratamientos Conservadores del Órgano/métodos , Resultado del TratamientoRESUMEN
Pediatric spine disorders are numerous and are quite different when compared with the adult population. This article focuses on some of the more common pediatric spine disorders. This article summarizes such disorders and discusses typical treatment options in the pediatric orthopedic armamentarium.
Asunto(s)
Enfermedades de la Columna Vertebral , Niño , Humanos , Enfermedad de Scheuermann/diagnóstico , Enfermedad de Scheuermann/terapia , Escoliosis/diagnóstico , Escoliosis/terapia , Enfermedades de la Columna Vertebral/diagnóstico , Enfermedades de la Columna Vertebral/terapia , Espondilólisis/diagnóstico , Espondilólisis/terapiaRESUMEN
Ninety-eight percent of skeletally immature patients with spinal cord injury (SCI) suffer from progressive neuromuscular scoliosis (NMS). Operative treatment has typically been limited to posterior spinal fusion (PSF), but a newer technique as described may be less invasive and preserve more function. A PSF of the entire spine to the pelvis is standard of care. However, maintenance of spinal flexibility, motion, and potential growth is desirable. We present a case for proof-of-concept of utilizing a surgical motion-preserving technique to treat progressive NMS in an 11year-old girl with T10 level (AIS B) paraplegia with a progressive 60° NMS of the lumbar spine. She had anterior scoliosis correction (ASC) from T11-L5 without fusion. Over 24 months, the curve growth-modulated to a residual of 12° with continued modulation to 7° at 3-year follow-up (skeletal maturity).
Asunto(s)
Enfermedades Neuromusculares/etiología , Complicaciones Posoperatorias/etiología , Escoliosis/cirugía , Traumatismos de la Médula Espinal/complicaciones , Accidentes de Tránsito , Niño , Femenino , Humanos , Vértebras Lumbares , Paraplejía/complicaciones , Escoliosis/etiologíaRESUMEN
BACKGROUND: Idiopathic scoliosis is a condition that may require surgical correction. Limitations of previous surgical modalities, however, created the need for novel methods of repair. One such technique, a newer form of anterolateral scoliosis correction, has shown considerable promise, which our center has had substantial experience performing. AIM: In this article, we present the case details of our first 105 patients for the purposes of describing the evolution and details of the anesthetic management and considerations for this procedure. METHODS: A retrospective review of medical records for 105 patients undergoing anterolateral instrumentation procedure for idiopathic scoliosis correction done at a single institution from May 2014 to June 2016 was performed. The details of perioperative management as well as surgical technique were reported for all patients. RESULTS: The mean age for patients was 14.8 years (range 10-18); the mean weight was 49.9 kg (range 25-82). Unilateral procedures were performed on 46.7%, with bilateral and hybrid procedures performed on 50.5% and 4.7%, respectively. The median number of levels corrected was 8 (interquartile range [IQR] 7-9) for unilateral, right 7 (IQR 6-7) and left 5 (IQR 4-5) for bilateral, and 4 (IQR 4-4.5) for hybrids. The average estimated blood loss (EBL) was 310 mL±138, with cell salvaged blood transfused in 61% of patients, and allogenic blood transfusion required in only two patients. CONCLUSIONS: The described anesthetic and analgesic management provides a framework for delivering perioperative care for this challenging procedure, which is gaining popularity as a modality for scoliosis correction.