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Masroor M, Virani QUA, Bakhshi SK, Siddiqui M, Shamim MS. Quality of Life of Children Treated for Split Cord Malformation. World Neurosurg 2024; 188:e163-e167. [PMID: 38762029 DOI: 10.1016/j.wneu.2024.05.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/11/2024] [Accepted: 05/13/2024] [Indexed: 05/20/2024]
Abstract
OBJECTIVE Split cord malformation (SCM), associated with neurologic deficits, necessitates surgical intervention for spinal cord detethering. Limited evidence exists regarding its impact on children's quality of life. Our study aims to evaluate the postoperative quality of life in children treated for SCM. METHODS This retrospective cohort study examined records of patients with SCM operated on between July 1, 2012, and July 31, 2022, at a single center. Data, including Health Utility Index-3 (HUI-3) scores provided by guardians, was collected to assess quality of life. Clinical and neurologic outcomes were also analyzed. RESULTS Twenty-five patients, predominantly female (68%), with a median age of 7 years, were included. Most presented with normal motor function (76%). The most common anatomic level of SCM was lumbar (12; 48%) followed by lumbosacral (5; 20%). A bony spur from the lamina was the most common cause of splitting the cord (64%). Over a median follow-up of 3.3 years, 64% of patients showed neurologic stability, 16% showed neurologic improvement, and 4% experienced deterioration. The mean HUI-3 score for 21 children was 0.93 ± 0.24. CONCLUSIONS Surgical management of SCM showed favorable neurologic outcomes and a positive long-term quality of life, as shown by HUI-3 scores. Our findings emphasize the efficacy of surgical intervention in improving the lives of children with this condition.
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Affiliation(s)
- Mehar Masroor
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Qurat-Ul-Ain Virani
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Saqib Kamran Bakhshi
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Malaika Siddiqui
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Muhammad Shahzad Shamim
- Section of Neurosurgery, Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan.
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Sun H, Huang Y, Dong Y, Jiao Y, Zhao J, Shen J. Safety of Traditional Growing Rods in Patients with Early-Onset Congenital Scoliosis Associated with Type-I Split Cord Malformation. J Bone Joint Surg Am 2024:00004623-990000000-01118. [PMID: 38815004 DOI: 10.2106/jbjs.23.01454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
BACKGROUND Literature regarding the application of traditional growing rod (TGR) instrumentation in patients with early-onset congenital scoliosis with type-I split cord malformation is scarce. The purpose of the present study was to assess the safety and effectiveness of TGR surgery and repeated lengthening procedures in patients with congenital scoliosis with type-I split cord malformation not treated with prophylactic osseous spur excision. METHODS Thirteen patients with early-onset congenital scoliosis associated with type-I split cord malformation and a stable neurologic status between March 2009 and July 2020 were recruited. All patients underwent primary TGR surgery and subsequent repeated lengthening procedures without osseous spur excision by the same surgical team. Clinical information and radiographic data from the preoperative, postoperative, and latest follow-up periods were collected. RESULTS The mean preoperative Cobb angle of the major coronal curve was 74.62° ± 25.59°, the mean early postoperative angle was 40.23° ± 17.89°, and the mean latest follow-up angle was 40.62° ± 16.60°. The scoliotic deformity correction percentage was 46.81% ± 12.26% after the initial operation and 45.08% ± 15.53% at the latest follow-up. Compared with the preoperative values, significant improvements were observed in the coronal and sagittal balance early postoperatively and at the latest follow-up (p < 0.05 for all). The average annual amounts of spinal height gained were 15.73 ± 5.95 mm at T1-S1, 8.94 ± 3.94 mm at T1-T12, and 12.02 ± 6.70 mm between the instrumented segments. The total height gained at T1-S1 and T1-T12 was 72.18 ± 28.74 mm and 37.62 ± 12.53 mm, respectively. No intraoperative neurophysiological monitoring events were observed, and no case of neurological deficit was observed postoperatively or during follow-up. CONCLUSIONS Patients without neurologic deficit and having a stable neurologic exam who have early-onset congenital scoliosis associated with type-I split cord malformation can safely and effectively undergo TGR surgery, followed by repeated lengthening procedures, without prophylactic osseous spur excision. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Heng Sun
- Department of Orthopedic Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, People's Republic of China
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Yang J, Sui W, Deng Y, Yang J, Huang Z. One-stage Spine-shortening Osteotomy Treated Severe Spinal Deformity Associated With Spinal Cord Malformations. Clin Spine Surg 2023; 36:E160-E166. [PMID: 36174203 DOI: 10.1097/bsd.0000000000001397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 08/17/2022] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN Retrospective case series. OBJECTIVE To evaluate the safety and efficacy of spine-shortening using 1-stage 3-column osteotomy for a severe rigid spinal deformity with a spinal cord malformation (SCM). SUMMARY OF BACKGROUND DATA One-stage spine-shortening osteotomy has been suggested for the treatment of a tethered spinal cord. However, the safety and efficacy of 1-stage spine-shortening osteotomy for the treatment of a severe spinal deformity with an SCM is not known. METHODS The records of 32 patients with a severe spinal deformity and SCM treated with spine-shortening using 3-column osteotomy from January 2010 to December 2016 were analyzed retrospectively. Intraoperative neurophysiological monitoring was used in all cases. Imaging parameters and neurological complications were analyzed to evaluate clinical safety and efficacy. RESULTS Spine-shortening using a 3-column osteotomy was conducted successfully in all 32 patients. The mean main coronal curve and maximum kyphotic angle were corrected from 119.8 and 119.1 degrees to 58.6 and 53.9 degrees, respectively, with the corrective rate of 51.4% and 54.3%. The mean correction loss of the major coronal curve and maximum kyphosis was 2.3 and 2.6 degrees, respectively, at a mean follow-up of 73.6 months. Intraoperative monitoring events occurred in 9 patients; of these 9 patients, 3 suffered transient SC injury, and all recovered within 1 year without suffering permanent paralysis. CONCLUSIONS Spine-shortening using a 3-column osteotomy seems to be safe and efficacious for treating a severe spinal deformity with an SCM. A deep understanding of the method and intensive intraoperative neuromonitoring improved the safety of this challenging and complex surgical procedure.
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Affiliation(s)
- Jingfan Yang
- Spine Center, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai
| | - Wenyuan Sui
- Spine Center, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai
| | - Yaolong Deng
- Spine Center, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai
| | - Junlin Yang
- Spine Center, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai
| | - Zifang Huang
- Department of Spine Surgery, the 3rd Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
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Kunes J, Quan T, Iyer R, Fano AN, Matsumoto H, Erickson M, McCarthy R, Brockmeyer D, Anderson RCE, Vitale MG. Reduced complication rate with simultaneous detethering and spinal deformity correction surgery compared to staged surgeries in patients with early onset scoliosis. Spine Deform 2022; 10:1473-1480. [PMID: 35821353 DOI: 10.1007/s43390-022-00550-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 06/25/2022] [Indexed: 10/17/2022]
Abstract
PURPOSE In patients with early onset scoliosis (EOS) and intraspinal anomalies, surgery may be necessary for both the tethered spinal cord (TSC) and spinal deformity. The purpose of this study was to determine if there is a difference in complications when TSC release and surgery for spinal deformity correction (SDC) are performed separately compared simultaneously. METHODS EOS patients with TSC who underwent detethering and SDC surgeries were identified through a multicenter registry. Patients were stratified into two groups. The simultaneous cohort consisted of patients receiving both detethering and SDC surgeries in a single anesthetic event on the same day, and the staged cohort consisted of patients undergoing detethering and SDC on two separate occasions. Postoperative complications up to 180 days for either surgery were assessed. RESULTS Twenty five (65.8%) patients were staged and 13 (34.2%) underwent a simultaneous approach. Percent curve correction following SDC surgery did not significantly differ between the groups (p = 0.36). Within 90 days postoperatively, 16 complications in 11 patients (44.0%) occurred in the staged group, whereas no complications occurred in the simultaneous cohort (p = 0.006). From 90-days to 180-days postoperatively, 4 additional complications in 3 patients (12.0%) occurred in the staged group, with no complications reported in the same timeframe for the simultaneous cohort. CONCLUSION To our knowledge, this is the largest multicenter comparative study to date, and it suggests that a simultaneous approach can be performed safely for EOS patients undergoing detethering and SDC surgeries, with a potentially lower risk profile than the traditional staged approach to these pathologies. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Jennifer Kunes
- Department of Orthopedic Surgery, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Irving Medical Center, ATTN: Theodore Quan, 3959 Broadway, CHONY 8-N, New York, NY, 10032, USA
| | - Theodore Quan
- Department of Orthopedic Surgery, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Irving Medical Center, ATTN: Theodore Quan, 3959 Broadway, CHONY 8-N, New York, NY, 10032, USA.
| | - Rajiv Iyer
- Department of Neurosurgery, Intermountain Primary Children's Hospital, University of Utah, Salt Lake City, UT, 84113, USA
| | - Adam N Fano
- Department of Orthopedic Surgery, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Irving Medical Center, ATTN: Theodore Quan, 3959 Broadway, CHONY 8-N, New York, NY, 10032, USA
| | - Hiroko Matsumoto
- Department of Orthopedic Surgery, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Irving Medical Center, ATTN: Theodore Quan, 3959 Broadway, CHONY 8-N, New York, NY, 10032, USA
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, 10032, USA
| | - Mark Erickson
- Department of Orthopaedics, Children's Hospital Colorado, Aurora, CO, 80045, USA
| | - Richard McCarthy
- Department of Orthopaedics, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, AR, 72205, USA
| | - Douglas Brockmeyer
- Department of Neurosurgery, University of Utah, Salt Lake City, UT, 84113, USA
| | - Richard C E Anderson
- New York University, Hassenfeld Children's Hospital at NYU Langone, New York, NY, 10016, USA
| | - Michael G Vitale
- Department of Orthopedic Surgery, Morgan Stanley Children's Hospital of New York Presbyterian, Columbia University Irving Medical Center, ATTN: Theodore Quan, 3959 Broadway, CHONY 8-N, New York, NY, 10032, USA
- Division of Pediatric Orthopaedic Surgery, New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, New York, NY, 10032, USA
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Uy MNAR, Tantengco OAG. Investigating the landscape and trajectory of spina bifida research in Asia: a bibliometric analysis. Childs Nerv Syst 2022; 38:1581-1591. [PMID: 35474541 DOI: 10.1007/s00381-022-05527-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/10/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Spina bifida is a type of a neural tube defect which affects 243.14 per 100,000 babies in Asia. Research articles on spina bifida have increased in the recent years. However, no study has focused on the research trends in this field in Asia. METHODS A systematic review of literature on spina bifida in Asia was performed using the Scopus database from inception to 2020. All published studies on spina bifida conducted in or published by authors from Asia were included in our analysis. Bibliometric information was obtained from Scopus and bibliometrics diagrams were created using VOSviewer software. RESULTS A total of 652 articles were obtained in this study. The number of publications showed an upward trend starting 2000s. The country with the greatest number of publications was Japan while All India Institute of Medical Sciences was the most productive institution in spina bifida research in Asia. The current focus of this field in Asia was prevalence of spina bifida, prenatal diagnosis, folic acid supplementation, and complications of spina bifida. Future areas of research in spina bifida include the genetic basis of neural tube defects and the use of stem cell technology as therapies for spina bifida. CONCLUSION This is the first bibliometric analysis on spina bifida in Asia. It showed the trend and future areas of research on spina bifida in Asia. Despite the increase in scientific literature on spina bifida research, more research outputs and collaborations are needed especially in developing countries in Asia.
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Affiliation(s)
| | - Ourlad Alzeus G Tantengco
- College of Medicine, University of the Philippines Manila, Pedro Gil Street, Ermita, Manila, Philippines.
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Minimum 5-year follow-up outcomes for one-stage posterior instrumentation without neurosurgery intervention for correction of scoliosis associated with Chiari I malformation and syringomyelia. Arch Orthop Trauma Surg 2022; 142:123-129. [PMID: 33125549 DOI: 10.1007/s00402-020-03636-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Accepted: 10/15/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Traditionally, the common belief has been that, all patients with Chiari I malformation (CM-1) and syringomyelia (SM) undergoing a neurosurgical procedure even if they are neurologically asymptomatic. As the pathology of CM-1 and SM has become better understood, the traditional concepts have been challenged. The objective of this study was to investigate the minimum 5-year follow-up clinical outcomes of surgical treatment of patients with scoliosis associated with CM-1 and SM and to evaluate the necessity of neurosurgical intervention before corrective surgery. METHODS This retrospective study was performed from May 2009 to September 2014. We enrolled 35 patients with scoliosis associated with CM-1 and SM who were undergoing spinal correction surgery without neurosurgical intervention. During the surgery, spinal cord monitor and wake-up test were used. Preoperative, postoperative, and final follow-up major curve coronary Cobb angle, correction rate, apical vertebral rotation (AVR), apical vertebral translation (AVT), thoracic kyphosis angle (T5-T12), lumbar lordosis angle (L1-S1) were analyzed on radiographs. RESULTS The mean follow-up period was 82.5 months. The preoperative and postoperative mean curve coronary Cobb angle was from 55.7 ± 7.5° to 20.1 ± 5.8°, correction rate was 63.9%, AVR from 2.8 ± 0.6° to 1.3 ± 0.5°, AVT from 5.1 ± 1.4 to 1.7 ± 0.7 cm, thoracic kyphosis angle from 18.7 ± 4.0° to 32.2 ± 2.7°, lumbar lordosis angle from 36.3 ± 4.1° to 43.8 ± 3.2°. No neurological deficits occurred during the operation and follow-up. CONCLUSIONS Our minimum 5-year follow-up outcomes showed that in a distinct patient population of neurologically asymptomatic individuals with CM-1, SM and progressive scoliosis, posterior instrumented spinal deformity surgery can be safely done without neurosurgical interverventions with the help of preoperative flexibility evaluation and intraoperative neuromonitoring.
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Li D, Anderson DE, Nockels RP. Surgical correction of pediatric spinal deformities with coexisting intraspinal pathology: A case report and literature review. Surg Neurol Int 2021; 12:381. [PMID: 34513148 PMCID: PMC8422436 DOI: 10.25259/sni_593_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 06/30/2021] [Indexed: 11/04/2022] Open
Abstract
Background Surgical correction of spinal deformities with coexisting intraspinal pathology (SDCIP) requires special consideration to minimize risks of further injury to an already abnormal spinal cord. However, there is a paucity of literature on this topic. Here, the authors present a pediatric patient with a residual pilocytic astrocytoma and syringomyelia who underwent surgical correction of progressive postlaminectomy kyphoscoliosis. Techniques employed are compared to those in the literature to compile a set of guidelines for surgical correction of SDCIP. Methods A systematic MEDLINE search was conducted using the following keywords; "pediatric," "spinal tumor resection," "deformity correction," "postlaminectomy," "scoliosis correction," "intraspinal pathology," "tethered cord," "syringomyelia," or "diastematomyelia." Recommendations for surgical technique for pediatric SDCIP correction were reviewed. Results The presented case demonstrates recommendations that primarily compressive forces on the convexity of the coronal curve should be used when performing in situ correction of SDCIP. Undercorrection is favored to minimize risks of traction on the abnormal spinal cord. The literature yielded 13 articles describing various intraoperative techniques. Notably, seven articles described use of compressive forces on the convex side of the deformity as the primary mode of correction, while only five articles provided recommendations on how to safely and effectively surgically correct SDCIP. Conclusion The authors demonstrated with their case analysis and literature review that there are no clear current guidelines regarding the safe and effective techniques for in situ correction and fusion for the management of pediatric SDCIP.
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Affiliation(s)
- Daphne Li
- Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, United States
| | - Douglas E Anderson
- Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, United States
| | - Russ P Nockels
- Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois, United States
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Ahuja K, Ifthekar S, Mittal S, Yadav G, Sudhakar PV, Barik S, Kandwal P. Is detethering necessary before deformity correction in congenital scoliosis associated with tethered cord syndrome: a meta-analysis of current evidence. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 30:599-611. [PMID: 33201289 DOI: 10.1007/s00586-020-06662-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 09/29/2020] [Accepted: 11/07/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare the clinical and radiological outcomes in patients with congenital scoliosis (CS) and tethered cord syndrome (TCS) undergoing deformity correction with (NI group) versus without (NNI group) prior neurosurgical intervention aimed at detethering the cord. METHODS A systematic review and meta-analysis were performed. The databases PubMed, Embase and Google Scholar were searched until March 2020. Inclusion criteria was studied describing performance of deformity correction and fusion surgery for congenital scoliosis with tethered cord syndrome with or without prior detethering procedure. Studies describing growth sparing procedures or congenital scoliosis associated with non-tethering pathologies such as syrinx were excluded. Case reports and series with less than 10 subjects were also excluded. NIH quality assessment tool was used for assessing quality of individual study. RESULTS Sixteen studies were included for analysis of which eight were found to be retrospective case series (level IV evidence) and retrospective case-control studies (level III evidence) each. Overall proportional meta-analysis found no significant difference in correction rate, operative duration, blood loss or complication rate between the NI and NNI groups. However, subgroup analysis performed after inclusion of only level III evidence studies revealed significantly lesser operative duration and blood loss with comparable correction and complication rate in NNI group. CONCLUSION Deformity correction and fusion surgery may be performed safely and effectively in CS with TCS patients without the need of a prior detethering procedure.
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Affiliation(s)
- Kaustubh Ahuja
- Department of Orthopaedic Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - Syed Ifthekar
- Department of Orthopaedic Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - Samarth Mittal
- Department of Orthopaedic Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - Gagandeep Yadav
- Department of Orthopaedic Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - P Venkata Sudhakar
- Department of Orthopaedic Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - Sitanshu Barik
- Department of Orthopaedic Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India
| | - Pankaj Kandwal
- Department of Orthopaedic Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, 249203, India.
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Posterior-Only Surgical Correction with Heavy Halo-Femoral Traction for the Treatment of Severe and Rigid Congenital Scoliosis Associated with Tethered Spinal Cord and Type II Split Cord Malformation. World Neurosurg 2020; 139:e151-e158. [PMID: 32251829 DOI: 10.1016/j.wneu.2020.03.145] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 03/24/2020] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate the safety and efficacy of posterior-only surgical correction with heavy halo-femoral traction for the treatment of severe and rigid congenital scoliosis (SRCS) associated with tethered spinal cord (TSC) and type II split cord malformation (SCM). METHODS Thirteen patients with SRCS associated with TSC and type II SCM underwent posterior-only surgical correction with heavy halo-femoral traction. The preoperative mean coronal Cobb angle was 88.87° ± 12.15°; the mean flexibility was 15.28% ± 3.88%; and the mean angle of thoracic kyphosis and lumbar lordosis was 39.63° ± 18.47° and 56.99° ± 10.02°, respectively. RESULTS The mean duration of surgery was 320 ± 43.64 minutes and the mean blood loss was 1422.31 ± 457.59 mL. The mean follow-up period was 24.46 ± 7.53 months. After heavy halo-femoral traction, the mean coronal Cobb angle was reduced to 59.14° ± 8.75°. After posterior-only surgical correction, postoperative mean coronal Cobb angle was further reduced to 33.85° ± 8.77°. The postoperative mean correction rate was 62.46% ± 5.04%. The postoperative mean angle of thoracic kyphosis and lumbar lordosis was 29.31° ± 6.75° and 47.79° ± 3.68°, respectively. At the final follow-up, the corrective loss rate of Cobb angle was only 0.69%. There were no significant differences between final follow-up and preoperative modified Japanese Orthopaedic Association total scores. The Scoliosis Research Society-22 total score improved at the final follow-up evaluation compared with the preoperative total score. CONCLUSIONS Without prophylactic neurosurgical intervention and spine-shortening osteotomy, posterior-only surgical correction with heavy halo-femoral traction could be safe and effective for the treatment of SRCS associated with TSC and type II SCM.
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Posterior-only surgical correction with heavy halo-femoral traction for the treatment of rigid congenital scoliosis associated with split cord malformation. BMC Musculoskelet Disord 2020; 21:98. [PMID: 32054465 PMCID: PMC7020551 DOI: 10.1186/s12891-020-3124-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 02/10/2020] [Indexed: 11/17/2022] Open
Abstract
Background Whether or not, prophylactic neurosurgical interventions of split cord malformation (SCM) before undertaking corrective surgery was the focus of debate. The present study was performed to evaluate the safety and efficacy of posterior-only surgical correction with heavy halo-femoral traction for the treatment of rigid congenital scoliosis (RCS) associated with SCM. Methods From 2011 to 2017, 24 patients suffered from RCS associated with SCM underwent posterior-only surgical correction with heavy halo-femoral traction. The apex of the deformity was lumbar (n = 9), thoracic (n = 11), and thoracolumbar (n = 4). There were 13 cases of failure of segmentation; 4 cases of failure of formation and 7 cases of mixed defects. Based on SCM classification, there were 14 patients with SCM type 1 and 10 patients with SCM type 2. The Scoliosis Research Society (SRS)-22 and modified Japanese Orthopaedic Association (mJOA) scores were assessed preoperatively and at the final follow up. Results The mean duration of surgery was 327.08 ± 43.99 min and the mean blood loss was 1303.33 ± 526.86 ml. The mean follow-up period was 20.75 ± 8.29 months. The preoperative mean coronal Cobb angle was 80.38° ± 13.55°; on the bending radiograph of the convex side, the mean Cobb angle was 68.91° ± 15.48°; the mean flexibility was 15.04% ± 7.11%. After heavy halo-femoral traction, the mean coronal Cobb angle was reduced to 56.89° ± 13.39°. After posterior-only surgical correction, postoperative mean coronal Cobb angle was further reduced to 32.54° ±11.33°. The postoperative mean correction rate was 60.51% ± 7.79%. At the final follow up, the corrective loss rate of Cobb angle was only 3.17%. The SRS-22 total score improved at the final follow-up evaluation compared with the preoperative SRS-22 total score. The spinal cord function was stable and there were no new neurological symptoms after correction. There were no significant differences between final follow-up and preoperative mJOA total scores. Conclusions Without prophylactic neurosurgical intervention and spine-shortening osteotomy, posterior-only surgical correction with heavy halo-femoral traction could be safe and effective for the treatment of RCS associated with SCM.
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Huang Z, Li X, Deng Y, Sui W, Fan H, Yang J, Yang J. The Treatment of Severe Congenital Scoliosis Associated With Type I Split Cord Malformation: Is a Preliminary Bony Septum Resection Always Necessary? Neurosurgery 2019; 85:211-222. [PMID: 30060239 DOI: 10.1093/neuros/nyy237] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 07/16/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Single-stage spine-shortening osteotomy without treating spinal cord malformations may have potential advantages for the treatment of severe congenital scoliosis (CS) with type I split spinal cord malformation (SSCM); however, the study of this technique was limited. OBJECTIVE To evaluate the safety and efficacy of a single-stage spine-shortening osteotomy in the treatment of severe CS associated with type I SSCM. METHODS A retrospective study was designed to compare 2 case series including 12 severe CS patients with type I SSCM and 26 patients with type A cord function (without spinal cord malformations, evoked potential abnormalities, and neurological dysfunctions preoperatively) treated with a single-stage spine-shortening posterior vertebral column resection (PVCR). Patient demographic, clinical, operative, and radiographic data were obtained and compared between groups. RESULTS The surgical procedure was successfully performed in both groups, and the patients were observed for an average of 44.9 mo (range 25-78 mo) after the initial surgery. The radiographic parameters, intraoperative data, and new neurological deficits showed no difference, while deformity angular ratio (SSCM group: control group = 16.6 ± 3.6: 20.1 ± 3.9, P = .01) and corrective rate (SSCM group: control group = 50%: 58%, P = .046) of the main curve were statistically different between groups. All of the new neurological deficits were recovered within 1 yr. CONCLUSION The single-stage spine-shortening PVCR with moderate correction could be applied to the treatment of CS associated with type I SSCM. This strategy can achieve safe spinal deformity correction while obviate the neurological complications brought by the detethering procedures, which merits further clinical investigation.
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Affiliation(s)
- Zifang Huang
- Department of Orthopaedic Surgery, The 1st Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xueshi Li
- Department of Orthopaedic Surgery, The 1st Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yaolong Deng
- Department of Orthopaedic Surgery, The 1st Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.,Spine Surgery Center, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Wenyuan Sui
- Department of Orthopaedic Surgery, The 1st Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.,Spine Surgery Center, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Hengwei Fan
- Department of Orthopaedic Surgery, The 1st Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jingfan Yang
- Department of Orthopaedic Surgery, The 1st Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.,Spine Surgery Center, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Junlin Yang
- Department of Orthopaedic Surgery, The 1st Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China.,Spine Surgery Center, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
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Zhao Q, Shi B, Sun X, Liu Z, Su H, Li Y, Zhu Z, Qiu Y. Do untreated intraspinal anomalies in congenital scoliosis impact the safety and efficacy of spinal correction surgery? A retrospective case-control study. J Neurosurg Spine 2019; 31:40-45. [PMID: 30952134 DOI: 10.3171/2019.1.spine181205] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 01/14/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Intraspinal anomalies associated with congenital scoliosis (CS) complicate the decision-making process for spinal correction surgery in CS patients. Recently, deformity correction surgery without prior prophylactic neurological intervention has been recognized to be safe in CS patients with intact or stable neurological status. However, no case-control study has identified the surgical outcomes and risks of spinal correction surgery in this patient population. The authors sought to investigate the safety and efficacy of spinal correction surgery for CS associated with untreated intraspinal anomalies (split cord malformation [SCM], tethered cord, and/or syringomyelia) with intact or stable neurological status. METHODS A group of CS patients with intraspinal anomalies (CS+IA) and another group of CS patients without intraspinal anomalies (CS-IA) undergoing 1-stage posterior correction surgery were retrospectively reviewed. The radiographic and clinical outcomes and postoperative complications were compared between the 2 groups. RESULTS There were 57 patients in the CS+IA group and 184 patients in the CS-IA group. No significant difference was observed in age, sex, spinal curve pattern, main Cobb angle, and flexibility of the main curve between the 2 groups (p > 0.05 for all). The postoperative correction rates of the major curve were comparable between the 2 groups (53.5% vs 55.7% for the CS+IA and CS-IA groups, respectively, p > 0.05). No significant difference was observed in the incidence of either implant-related or neurological complications between 2 groups. No patients in the CS+IA group developed neurological complications, whereas 1 patient in the CS-IA group experienced transient weakness of the left lower extremity after surgery. CONCLUSIONS Coexisting intraspinal anomalies (SCM, tethered cord, and/or syringomyelia) in CS patients with normal or stable neurological status do not significantly increase the risk of neurological complications of correction surgery. Prophylactic neurosurgical intervention for intraspinal anomalies before correction surgery might be unnecessary for these patients.
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Affiliation(s)
- Qinghua Zhao
- 1Department of Orthopedics, Luhe People's Hospital of Nanjing; and
| | - Benlong Shi
- 2Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Xu Sun
- 2Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Zhen Liu
- 2Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Hao Su
- 2Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Yang Li
- 2Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Zezhang Zhu
- 2Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Yong Qiu
- 2Spine Surgery, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
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Is It Better to Resect a Bony Spur Before Corrective Surgery for Congenital Scoliosis with Type I Split Cord Malformation? World Neurosurg 2019; 125:e1151-e1159. [DOI: 10.1016/j.wneu.2019.01.265] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 01/25/2019] [Accepted: 01/28/2019] [Indexed: 11/22/2022]
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Management of concomitant scoliosis and tethered cord syndrome in non-spina bifida pediatric population. Childs Nerv Syst 2017; 33:1899-1903. [PMID: 28695338 DOI: 10.1007/s00381-017-3504-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 06/26/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND The management of concomitant scoliosis and tethered cord syndrome in the non-spina bifida pediatric population is challenging. In the present study, we evaluate the efficacy of different treatment modalities and propose a treatment plan for the management of affected patients. METHODS A systematic literature review was conducted by querying the MEDLINE, PubMed, Cochrane, EMBASE, Scopus, and Web of Science databases for papers published between January 1996 and June 2016 and reporting on concomitant scoliosis and tethered cord. We excluded animal studies, non-English papers as well as papers reporting on patients with multiple concomitant intraspinal anomalies such as spina bifida. RESULTS Out of 1993 articles, only 13 met our inclusion criteria. These 13 articles described six main management approaches: Observation, cord untethering only, cord untethering followed by deformity correction, simultaneous cord untethering and deformity correction, and deformity correction without untethering. Selection of the best approach is a function of the patient's symptomatology and Cobb angle. CONCLUSION We propose treatment plan for the management of patients with concomitant tethered cord syndrome and spinal deformity. Asymptomatic patients can be followed conservatively and managed as scoliosis patients with no need for untethering. Surgical management in a staged fashion seems appropriate in symptomatic patients with a Cobb angle less than 35°. In these patients, deformity can improve following untethering, thus sparing the patient the risks of surgical correction of scoliosis. Staged or non-staged cord untethering and curve correction seem to be adequate in symptomatic patients with Cobb angle >35° as these patients are likely to require both untethering and deformity correction.
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Feng F, Tan H, Li X, Chen C, Li Z, Zhang J, Shen J. Radiographic characteristics in congenital scoliosis associated with split cord malformation: a retrospective study of 266 surgical cases. BMC Musculoskelet Disord 2017; 18:420. [PMID: 29058584 PMCID: PMC5651595 DOI: 10.1186/s12891-017-1782-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 10/12/2017] [Indexed: 12/02/2022] Open
Abstract
Background Vertebrae, ribs, and spinal cord are anatomically adjacent structures, and their close relationships are clinically important for planning better corrective surgical approach. The objective is to identify the radiographic characteristics in surgical patients with congenital scoliosis (CS) and coexisting split cord malformation (SCM). Methods A total of 266 patients with CS and SCM underwent surgical treatment at our hospital between May 2000 and December 2015 was retrospectively identified. The demographic distribution and radiographic data were collected to investigate the characteristics of spine curve, vertebral, rib, and intraspinal anomalies. According to Pang’s classification, all patients were divided into two groups: type I group is defined as two hemicords, each within a separate dural tube separated by a bony or cartilaginous medial spur, while type II group is defined as two hemicords within a single dural tube separated by a nonrigid fibrous septum. Results There were 104 patients (39.1%) in Type I group and 162 patients (60.9%) in Type II group. SCM was most commonly found in the lower thoracic and lumbar regions. The mean length of the septum in Type I SCM was significantly shorter than Type II SCM (2.7 vs. 5.2 segments). Patients in Type I group had a higher proportion of kyphotic deformity (22.1%). The vertebral deformities were simple in only 16.5% and multiple in 83.5% of 266 cases. Patients in Type I group presented higher prevalence of multiple (90.4%) and extensive (5.1 segments) malformation of vertebrae. In addition, hypertrophic lamina and bulbous spinous processes were more frequent in Type I group (29.7%), even developing into the “volcano-shape” deformities. Rib anomalies occurred in 62.8% of all patients and 46.1% of them were complex anomalies. The overall prevalence of other intraspinal anomalies was 42.9%. The most common coexisting intraspinal anomalies was syringomyelia (30.5%). Conclusion The current study, with the largest cohort to date, demonstrated that patients with CS and coexisting SCM presented high prevalence of multiple vertebral deformities, rib and intraspinal anomalies. The length of the split segment in Type I SCM was shorter than that in Type II SCM. Compared with Type II SCM, patients with Type I SCM presented with higher incidence of kyphotic deformity, more extensive and complicated vertebral anomalies, and more complex rib anomalies.
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Affiliation(s)
- Fan Feng
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, China
| | - Haining Tan
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, China
| | - Xingye Li
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, China
| | - Chong Chen
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, China
| | - Zheng Li
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, China
| | - Jianguo Zhang
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, China
| | - Jianxiong Shen
- Department of Orthopedics, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, China. .,Department of Orthopedic Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Peking Union Medical College, No. 1 Shuai Fu Yuan, Wang Fu Jing Street, Beijing, 100730, China.
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Udayakumaran S, Menon SK, Onyia CU, Tahasildar N. Single-stage deformity correction in children with neurogenic kyphoscoliosis: nuances and a proposal for risk stratification. Neurosurg Focus 2017; 43:E13. [PMID: 28965455 DOI: 10.3171/2017.7.focus17348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Neurogenic kyphoscoliosis in pediatric patients has varied causes and diverse management options. The most common management strategy is to stage the orthopedic and neurosurgical aspects of the correction at an interval of 3-6 months from each other. The aim of this study was to report the authors' experience with correction of deformity in children with associated neurological abnormalities requiring intervention as a single-stage surgical treatment. METHODS Of 591 pediatric patients with scoliosis treated at the Amrita Institute of Medical Sciences and Research Centre between January 2001 and January 2011, the authors identified all patients with neurogenic kyphoscoliosis who underwent deformity correction and a neurosurgical procedure in the same surgical session when they were younger than 15 years. Data regarding the demographic details, preoperative Cobb angle/kyphotic angle, surgical details, postoperative complications, cost of the procedure, and long-term neurological outcome were collected for each case and analyzed. Based on the results of this analysis, the authors propose a 2-category risk stratification system for the timing of deformity correction depending on the primary neurogenic etiology. RESULTS Ten cases involving patients with neurogenic kyphoscoliosis requiring both deformity correction and neurosurgical procedure met the criteria and were included in the analysis. All 10 patients were younger than 15 years; their mean age was 10.8 years. The average Cobb angle was 59.5°. Five patients underwent foramen magnum decompression, 5 patients underwent spinal cord detethering, and 1 patient had intraspinal intradural tumor excision. The mean estimated blood loss was 1177 ml (range 700-1550 ml), and the mean operative time was 4.4 hours (range 3-5.5 hours). There were no intraoperative complications. None of the patients had any new postoperative neurological deficits. The mean postoperative Cobb angle of the main thoracic curve was 12.6°. CONCLUSIONS Simultaneous deformity correction along with a definitive neurosurgical procedure in patients with neurogenic kyphoscoliosis can be performed without added morbidity and avoids both the added costs and the risk of complications associated with a second surgery. The risk stratification system proposed in this paper may serve as a guideline for case selection and help to optimize outcome.
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Affiliation(s)
| | - Sajesh K Menon
- Spine Surgery, Department of Neurosurgery, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala
| | - Chiazor U Onyia
- Neurosurgery Division, Department of Surgery, Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
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Clinical Outcomes of Different Surgical Strategy for Patients With Congenital Scoliosis and Type I Split Cord Malformation. Spine (Phila Pa 1976) 2016; 41:1310-1316. [PMID: 26913465 DOI: 10.1097/brs.0000000000001530] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective study. OBJECTIVE To compare the clinical outcomes of different surgical strategy for patients with congenital scoliosis (CS) and type I split cord malformation (SCM). SUMMARY OF BACKGROUND DATA CS associated with type I SCM is a challenge for spine surgeon because of the high potential rate of neurological compromise. Traditionally, bony spur resection (BR) has been indicated before any procedure for scoliosis correction. METHODS From May 2002 to February 2013, 82 CS patients with type I SCM who underwent corrective surgery at our center were retrospectively reviewed. There were 20 male and 62 female patients with an average age of 13.8 years (4-39 yrs) at surgery. They were divided into two groups according to different surgical strategy. The patients in the BR group underwent staged prophylactic neurosurgery or one-stage BR before corrective surgery, whereas patients in the nonresection (NR) group underwent one-stage corrective surgery without addressing bony spur. RESULTS There were 15 patients in the BR group and 67 patients in the NR group. No significant differences were detected in preoperative characteristics between two groups. The average follow up was 37 months (24-105 months). In the BR group, the correction rate was 53.0% and 45.9% at the final follow up. Whereas, in the NR group, the correction rate was 48.5% and 42.1% at the final follow up. Compared with the NR group, the operation time and blood loss were statistically higher in the BR group. Five patients experienced transient neurological complications and one patient in the BR group suffered permanent neurological damage of incomplete loss bladder control. CONCLUSION One-stage corrective surgery could be safe and effective for patients with CS and SCM. For patients with intact or stable neurological status, prophylactic neurosurgical intervention to remove bony spur before curve correction may not be necessary. LEVEL OF EVIDENCE 4.
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Shen J, Zhang J, Feng F, Wang Y, Qiu G, Li Z. Corrective Surgery for Congenital Scoliosis Associated with Split Cord Malformation: It May Be Safe to Leave Diastematomyelia Untreated in Patients with Intact or Stable Neurological Status. J Bone Joint Surg Am 2016; 98:926-36. [PMID: 27252437 DOI: 10.2106/jbjs.15.00882] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The treatment of congenital scoliosis associated with split cord malformation (SCM) raises the issue of how to best manage such patients to avoid neurological deficit while achieving a satisfactory correction. METHODS This prospective clinical study was performed at our center from March 2000 through June 2013. We enrolled a total of 214 patients (61 male and 153 female) with congenital scoliosis associated with SCM who were undergoing spinal correction surgery. The mean age at surgery was 14.1 years. The inclusion criteria were congenital scoliosis with confirmed SCM; status as neurologically intact or stable over the preceding 2 years; and no neurological deterioration as evidenced on traction, side-bending, or fulcrum-bending radiographs. Patients with unstable neurological status or for whom vertebral column resection surgery was planned were excluded. All patients underwent scoliosis surgery without prophylactic detethering. RESULTS On the basis of the Pang classification, 73 patients were in the type-I SCM group, and 141 were in the type-II SCM group. The groups did not differ significantly with respect to preoperative characteristics, operative time, blood loss, or number of levels fused. The mean follow-up was 37 months (range, 24 to 108 months). The rate of scoliosis correction was lower in the type-I group than in the type-II group (p < 0.05). In the type-I group, the correction rate was 48.9% at 1 week postoperatively and 42.2% at the last follow-up. In the type-II group, the correction rate was 54.7% at 1 week postoperatively and 47.9% at the last follow-up. Eleven (5.1%) of the patients experienced transient neurological complications, with no significant difference between the groups (p = 0.415). No patient experienced permanent neurological deficit during surgery or follow-up. CONCLUSIONS Patients with congenital scoliosis associated with SCM, regardless of type, can safely and effectively undergo spinal deformity correction and achieve spinal balance without neurological intervention. For such patients with intact or stable neurological status, prophylactic detethering prior to scoliosis surgery may not be necessary. LEVEL OF EVIDENCE Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Jianxiong Shen
- Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, People's Republic of China
| | - Jianguo Zhang
- Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, People's Republic of China
| | - Fan Feng
- Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, People's Republic of China
| | - Yipeng Wang
- Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, People's Republic of China
| | - Guixing Qiu
- Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, People's Republic of China
| | - Zheng Li
- Department of Orthopedics, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, Beijing, People's Republic of China
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Fekete TF, Haschtmann D, Heyde CE, Kleinstück F, Jeszenszky D. [Congenital malformations of the growing spine : When should treatment be conservative and when should it be surgical?]. DER ORTHOPADE 2016; 45:518-26. [PMID: 27225659 DOI: 10.1007/s00132-016-3275-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Congenital malformations of the spine are caused by genetic and teratogenic factors. By means of asymmetrical longitudinal growth of the spine they can lead to deformity, most commonly to scoliosis. The malformations can be classified as failure of formation, failure of segmentation and mixed-type malformations. The extent of the deformity and its progression are determined by the remaining growth potential and the location and type of malformation. Up to one third of such deformities are associated with some sort of cardiac or urogenital malformation. The treatment concept is typically determined on an individual basis. Mild deformities often remain undetected. Conservative treatment using a brace has no substantial effect on the primary curve but might be helpful in the treatment of long sweeping, flexible, secondary curves. If rapid progression is documented or expected, surgical intervention as early as possible is warranted to prevent secondary structural changes. The surgical treatment should be focused on and limited to the site of malformation. The aim of surgery is the correction of the deformity at the site of asymmetrical growth. This can be achieved either by resection of a hemivertebra or by performing a vertebral column resection or other type of osteotomy. If notable compensatory, secondary curves are present, these can be corrected with growing rod constructs. The aim of all types of treatment is the correction of existing deformity or the prevention of its progression, in order to ensure balanced growth of the healthy regions of the spine. The present paper discusses the conservative and surgical treatment modalities available to achieve these aims.
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Affiliation(s)
- T F Fekete
- Wirbelsäulenchirurgie, Muskulo-Skelettal Zentrum, Schulthess Klinik, Lengghalde 2, 8008, Zürich, Schweiz
| | - D Haschtmann
- Wirbelsäulenchirurgie, Muskulo-Skelettal Zentrum, Schulthess Klinik, Lengghalde 2, 8008, Zürich, Schweiz
| | - C-E Heyde
- Klinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Bereich Wirbelsäulenchirurgie, Universität Leipzig, Liebigstraße 20, 04103, Leipzig, Deutschland
| | - F Kleinstück
- Wirbelsäulenchirurgie, Muskulo-Skelettal Zentrum, Schulthess Klinik, Lengghalde 2, 8008, Zürich, Schweiz
| | - D Jeszenszky
- Wirbelsäulenchirurgie, Muskulo-Skelettal Zentrum, Schulthess Klinik, Lengghalde 2, 8008, Zürich, Schweiz.
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Safety and Efficacy of One-stage Spinal Osteotomy for Severe and Rigid Congenital Scoliosis Associated with Split Spinal Cord Malformation. Spine (Phila Pa 1976) 2015; 40:E1005-13. [PMID: 26165211 DOI: 10.1097/brs.0000000000001039] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective clinical study. OBJECTIVE To retrospectively evaluate the safety and efficacy of one-stage spinal osteotomy in the treatment of severe and progressive congenital scoliosis (CS) associated with split spinal cord malformation (SSCM). SUMMARY OF BACKGROUND DATA For severe and rigid spinal deformity, spinal osteotomies are often advocated for correcting the deformity. However, the safety and efficacy of one-stage spinal osteotomy in the treatment of severe and rigid CS with SSCM have been unclear thus far. METHODS Patients were treated by one-stage spinal osteotomy between September 2007 and June 2011 in our hospital. The clinical records were reviewed for demographic and radiographical data, operative time, intraoperative blood loss, blood transfusion, perioperative complications, and functional outcomes. RESULTS There were 18 females and 11 males with an average age of 15.5 ± 3.6 years (range, 12-28 yr). Spinal cord was longitudinally split by a bony spur in 11 patients (type I SSCM) and by a fibrous band in 18 patients (type II SSCM). Patients were observed for a minimum of 24 months after initial surgical treatment with an average follow-up of 43.0 ± 17.1 months (range 24-68 mo) from September 2007 to June 2013. The mean operative time and average blood loss of type ISSCM was significantly greater than those of type II SSCM (P < 0.05). The major curve was corrected from an average of 97.2°± 17.8° to 35.7°± 15.9°, a mean correction rate of 64.3% ± 11.0%. The average loss of correction at final follow-up was 2.9% for major curves. The overall complication rate was 24.1%, including transient neurological deterioration in 3 patients, cerebrospinal fluid leakage in 2 patients, urinary tract infection in 1 patient and pleural rupture in 1 patient. CONCLUSION Relative to multistage corrective surgery, one-stage spinal osteotomy is effective for the correction of severe CS and SSCM without increasing the rate of surgical complications. However, surgical treatment of type I SSCM does require more operating time and blood loss. LEVEL OF EVIDENCE 4.
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Shi Z, Li Q, Cai B, Yu B, Feng Y, Wu J, Li M, Ran B. Causes of the failure and the revision methods for congenital scoliosis due to hemivertebra. Congenit Anom (Kyoto) 2015; 55:150-4. [PMID: 25711333 DOI: 10.1111/cga.12107] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 02/13/2015] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to retrospectively investigate the causes of failure in the first operation and the revision procedure for patients with congenital scoliosis due to hemivertebra. Nineteen patients who underwent the revision operations because of failure in the first operation were included in this study. All the malformations were identified as fully segmented hemivertebra, including 16 cases in thoracolumbar vertebra (T10: three patients; T12: seven patients; L1: six patients), and three cases in thoracic vertebra (T8). The causes of failure in the first operation and the outcome of revision procedure for patients were retrospectively analyzed. All patients were successfully performed the personalized revision surgeries. The failure reasons of the first operation included limitations of the first operation procedure, no or incomplete resection of the malformed hemivertebra, improper operation during surgery, improper internal fixation material, and improper internal fixation scope. The average postoperative scoliosis Cobb's angle and kyphosis Cobb's angle were corrected from 54.1° preoperatively to 23.1° postoperatively, and 59.3° preoperatively to 25.8° postoperatively, respectively. The average postoperative distance between the C7 plumb line and the center sacral vertical line was decreased from 2.5 cm preoperatively to 1.5 cm postoperatively. The average follow-up period was 2.2 years. No serious complication was observed. The cause of the failure of the first operations for the congenital scoliosis due to hemivertebra is verified. Our study may provide a basis for the treatment of congenital scoliosis due to hemivertebra.
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Affiliation(s)
- Zhicai Shi
- Department of Orthopedics, Changhai Hospital of Shanghai, Shanghai, China
| | - Quan Li
- Department of Orthopedics, Changhai Hospital of Shanghai, Shanghai, China
| | - Bin Cai
- Department of Orthopedics, Changhai Hospital of Shanghai, Shanghai, China
| | - Baoqing Yu
- Department of Orthopedics, Shanghai Pudong Hospital, FuDan University Pudong Medical Center, Shanghai, China
| | - Yuan Feng
- Department of Orthopedics, First Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Jibin Wu
- Department of Orthopedics, First Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Ming Li
- Department of Orthopedics, Changhai Hospital of Shanghai, Shanghai, China
| | - Bo Ran
- Department of Orthopedics, Shanghai Pudong Hospital, FuDan University Pudong Medical Center, Shanghai, China
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Heidenreich M, Baghdadi YMK, McIntosh AL, Shaughnessy WJ, Dekutoski MB, Stans A, Larson AN. At What Levels Are Freehand Pedicle Screws More Frequently Malpositioned in Children? Spine Deform 2015; 3:332-337. [PMID: 27927478 DOI: 10.1016/j.jspd.2014.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 11/08/2014] [Accepted: 12/15/2014] [Indexed: 11/16/2022]
Abstract
STUDY DESIGN Retrospective case series. BACKGROUND Previous studies report that 5% to 17% of pedicle screws placed in children are malpositioned. Knowledge of the long-term effects of malpositioned screws is limited. We sought to further characterize risk factors for malpositioned pedicle screws in order to establish a more proactive role in limiting future complications. OBJECTIVE We undertook this study to answer the following: 1) Is the rate of freehand pedicle screw malpositioning higher in children with spinal deformity, particularly at the apical concavity? 2) At what vertebral levels do freehand pedicle screws have the highest rates of malpositioning? 3) In which direction (medial or lateral) do freehand pedicle wall violations occur most often? METHODS Incidental postoperative computed tomographic (CT) exams were retrospectively reviewed in 85 pediatric patients (605 screws) treated with posterior spinal fusion using freehand pedicle screw technique. Of the screws imaged, 355 were in patients without deformity and 250 in patients with deformity. Breaches were categorized as mild (<2 mm), moderate (2-4 mm), or severe (>4 mm). RESULTS Screws in pediatric deformity patients were more frequently malpositioned by 2 mm or more than were screws in patients without deformity (26% vs. 19%, p = .02). In patients with deformity, no higher rate of screw malposition was detected at the apical region. Overall, the highest rates of severe screw malposition were between T3 and T8. Pedicle breaches were more commonly in a medial direction compared with lateral (74% vs. 26%, p < .0001). However, severe breaches within the T3-T8 region were more often directed lateral than medial (92% vs. 8%, p ≤ .0001). CONCLUSIONS The clinical significance of asymptomatic pedicle screw breaches in children has not yet been determined. In this study, screws at the apical concavity were no more likely to be malpositioned than those at other sites. Efforts to reduce pedicle screw malposition would likely be most effective at the T3-T8 levels. LEVEL OF EVIDENCE Level IV, Therapeutic Study. See the Guidelines for Authors for a complete description of the levels of evidence.
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Affiliation(s)
- Mark Heidenreich
- Mayo Medical School, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Yaser M K Baghdadi
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Amy L McIntosh
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - William J Shaughnessy
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Mark B Dekutoski
- The CORE Institute, 18444 North 25th Avenue Suite 320, Phoenix, AZ 85023, USA
| | - Anthony Stans
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - A Noelle Larson
- Department of Orthopedic Surgery, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
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Gauthier LE, Mandourah Y, Soroceanu A, McIntosh AL, Flynn JM, El-Hawary R. Perioperative Neurologic Injury Associated With Rib-Based Distraction Surgery. Spine Deform 2014; 2:481-488. [PMID: 27927410 DOI: 10.1016/j.jspd.2014.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 06/18/2014] [Accepted: 08/08/2014] [Indexed: 10/24/2022]
Abstract
STUDY DESIGN Retrospective, comparative case series from the study group database. OBJECTIVES The primary objective was to report the neurologic injury rate for rib-based distraction surgery and determine whether preoperative diagnosis affects this rate. The secondary objective was to describe these injuries and outcome. SUMMARY OF BACKGROUND DATA Posterior distraction-based systems are commonly used to treat early-onset scoliosis. General complication rates for these surgeries are high; however, there are few reports in the literature on neurologic injury after rib-based distraction surgery. METHODS This was a retrospective review of the Children's Spine Study Group database from 2004 to 2013. The researchers used the chi-square test to compare the distributions of proportions between diagnoses. RESULTS A total of 524 patients were identified and treated with rib-based distraction surgery. The preoperative diagnoses consisted of 222 congenital/structural, 163 neuromuscular, 63 syndromic, 67 idiopathic, and 9 unknown. There were 9 neurologic injuries (7 clinical and 2 neuromonitoring alerts) for a neurologic injury rate of 1.7%. Using the Classification for Early-Onset Scoliosis, 8 patients were classified as congenital and 1 as neuromuscular. The neurologic injury rate in the congenital curves group was 3.6% and was 0.34% in non-congenital curves (p = .005). The proportion of injured patients with an additional secondary diagnosis was 3.82%, compared with 0.82% patients with only a primary diagnosis (p = .01). Eight injuries occurred at initial implantation and 1 at revision surgery. Most were brachial plexus (n = 5) with no complete spinal cord injuries. Four patients required return to surgery and 1 needed intraoperative intervention. At 4.2 years' follow-up, 7 of 9 patients had full resolution of symptoms and 2 patients had residual upper extremity weakness. CONCLUSIONS The rate of neurologic injury for patients treated with rib-based distraction surgery was 1.7%. Most injuries occurred with congenital diagnoses and they were more likely in patients with additional secondary diagnoses. These injuries were predominantly to the brachial plexus and generally resolved.
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Affiliation(s)
- Luke E Gauthier
- Division of Orthopaedic Surgery, IWK Health Centre, 5850 University Avenue, PO Box 9700, Halifax NS, Nova Scotia B3K 6R8, Canada
| | - Yousef Mandourah
- Division of Orthopaedic Surgery, IWK Health Centre, 5850 University Avenue, PO Box 9700, Halifax NS, Nova Scotia B3K 6R8, Canada
| | - Alexandra Soroceanu
- Division of Orthopaedic Surgery, IWK Health Centre, 5850 University Avenue, PO Box 9700, Halifax NS, Nova Scotia B3K 6R8, Canada
| | - Amy L McIntosh
- Department of Orthopaedic Surgery, Mayo Clinic, Gonda Bldg 14 Fl, 200 First St. SW, Rochester, MN 55905, USA
| | - John M Flynn
- Department of Orthopaedic Surgery, Children's Hospital of Philadelphia, Wood Bldg 2nd Fl, 34th & Civic Center Blvd, Philadelphia, PA 19104, USA
| | - Ron El-Hawary
- Division of Orthopaedic Surgery, IWK Health Centre, 5850 University Avenue, PO Box 9700, Halifax NS, Nova Scotia B3K 6R8, Canada.
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Key role for the transcriptional factor, osterix, in spine development. Spine J 2014; 14:683-94. [PMID: 24268393 DOI: 10.1016/j.spinee.2013.08.039] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Revised: 08/06/2013] [Accepted: 08/23/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Osterix (Osx) is an important transcriptional factor for bone formation; however, its role in spine development has not been determined. PURPOSE The goal of the present study is to observe the role of Osx in spine development. STUDY DESIGN/SETTING Deletion and overexpression of Osx were achieved in Osx knockout and transgenic mice, respectively, to determine the effect of Osx on spine development. METHODS With 2.3-kb type I collagen as a promoter, Osx were deleted in mice, and overexpression of Osx was obtained in Osx transgenic mice. Video, X-ray radiology, histology, tartrate-resistant acid phosphatase staining, Safranin O staining, and immunohistochemistry were used to assess the effect of Osx deletion and overexpression on spine development. This study was supported by National Science Foundation of China (81271935) and Foundation of State Key Laboratory of Trauma, Burns and combined injury (SKLZZ SKLZZ201124). No potential conflict of interest to disclose. RESULTS Overexpression of Osx did not have an obvious effect on spine development, whereas deletion of Osx led to severe spine deformities that included wedged vertebrae, spinal stenosis, and congenital scoliosis. Also, Osx deactivation resulted in shortened vertebrae and excessive bone volume in the vertebrae. TRAP staining showed that activity of osteoclasts decreased in Osx-null mice, and examination with TdT-mediated dUTP nick end labeling revealed that the apoptosis rate at the growth plate decreased significantly in Osx-null mice. Excessive formation of bone was positive for Safranin O staining. CONCLUSIONS Osx plays an important role in spine development, and its deactivation leads to severe spine deformities.
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Balioğlu MB, Albayrak A, Atıcı Y, Tacal MT, Kaygusuz MA, Yıldırım CH, Kaya M, Taşdemiroğlu E, Akbaşak A. Scoliosis-Associated Cervical Spine Pathologies. Spine Deform 2014; 2:131-142. [PMID: 27927379 DOI: 10.1016/j.jspd.2013.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 09/16/2013] [Accepted: 11/02/2013] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN A total of 126 scoliosis patients admitted to the hospital were screened for concomitant cervical pathologies. OBJECTIVES To investigate the prevalence of cervical spine pathologies and the clinical relevance of magnetic resonance imaging (MRI) in the evaluation of patients with neuromuscular, congenital, syndromic, and idiopathic scoliosis. BACKGROUND SUMMARY With the development of MRI, upper neural axis abnormalities such as syringomyelia and Chiari malformation are increasingly being found in patients with scoliosis, but no report in the literature describes other pathologies in the cervical area seen concomitant with different scoliosis types. METHODS A total of 126 consecutive patients who were classified as having neuromuscular, congenital, syndromic, and idiopathic scoliosis were retrospectively evaluated. Data regarding cervical neural axis abnormalities obtained from the MRI studies were analyzed and classified into each type of scoliosis group. RESULTS A total of 126 patients with scoliosis were evaluated for hindbrain and cervical spine anomalies. Patients were divided into 4 groups regarding the type of scoliosis. The cervical spine of all patients was evaluated with MRI and other radiologic methods when needed. The most frequently seen pathology was syringomyelia. Other pathologies found included congenital vertebral anomalies, Chiari malformation, arachnoid cyst, atlanto-axial dissociation, split cord, posterior vertebral fusion, vertebral hypoplasia, neurenteric cyst, myelomalacia, dermoid cyst, and decrease in craniovertebral angle. Cervical pathologies were most frequently seen in neuromuscular scoliosis, followed by congenital and syndromic groups. CONCLUSIONS Cervical spinal pathologies vary according to the type of scoliosis. The number of cervical spinal pathologies diagnosed in idiopathic scoliosis patients was least compared with neuromuscular and syndromic groups. The most common pathology was syringomyelia, followed by congenital vertebral anomalies and cerebral tonsillar hernia. Preoperative MRI scan provides vital information regarding cervical spinal pathologies encountered in scoliosis patients.
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Affiliation(s)
- Mehmet B Balioğlu
- Department of Orthopaedics and Traumatology, Disease of the Spine Surgery Group, Metin Sabanci Baltalimani Disease of the Bone Education and Research Hospital, Rumeli Hisari cd No: 62, 34470 Baltalimani Istanbul, Turkey.
| | - Akif Albayrak
- Department of Orthopaedics and Traumatology, Disease of the Spine Surgery Group, Metin Sabanci Baltalimani Disease of the Bone Education and Research Hospital, Rumeli Hisari cd No: 62, 34470 Baltalimani Istanbul, Turkey
| | - Yunus Atıcı
- Department of Orthopaedics and Traumatology, Disease of the Spine Surgery Group, Metin Sabanci Baltalimani Disease of the Bone Education and Research Hospital, Rumeli Hisari cd No: 62, 34470 Baltalimani Istanbul, Turkey
| | - Mehmet T Tacal
- Department of Orthopaedics and Traumatology, Disease of the Spine Surgery Group, Metin Sabanci Baltalimani Disease of the Bone Education and Research Hospital, Rumeli Hisari cd No: 62, 34470 Baltalimani Istanbul, Turkey
| | - Mehmet A Kaygusuz
- Department of Orthopaedics and Traumatology, Disease of the Spine Surgery Group, Metin Sabanci Baltalimani Disease of the Bone Education and Research Hospital, Rumeli Hisari cd No: 62, 34470 Baltalimani Istanbul, Turkey
| | - Can H Yıldırım
- Department of Neurosurgery, Kafkas University, School of Medicine, Kafkas Universitesi Kampusu Saglik Arastirma ve Uygulama Hastanesi, 36100 Kars, Turkey
| | - Miktat Kaya
- Department of Neurosurgery, Kafkas University, School of Medicine, Kafkas Universitesi Kampusu Saglik Arastirma ve Uygulama Hastanesi, 36100 Kars, Turkey
| | - Erol Taşdemiroğlu
- Department of Neurosurgery, Kafkas University, School of Medicine, Kafkas Universitesi Kampusu Saglik Arastirma ve Uygulama Hastanesi, 36100 Kars, Turkey
| | - Aytaç Akbaşak
- Department of Neurosurgery, Kafkas University, School of Medicine, Kafkas Universitesi Kampusu Saglik Arastirma ve Uygulama Hastanesi, 36100 Kars, Turkey
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Oda JE, Shah SA, Mackenzie WG, Akbarnia BA, Yazici M. Concurrent tethered cord release and growing-rod implantation-is it safe? Global Spine J 2012; 2:207-12. [PMID: 24353969 PMCID: PMC3864420 DOI: 10.1055/s-0032-1330941] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Accepted: 10/15/2012] [Indexed: 01/24/2023] Open
Abstract
Study Design Retrospective case series from one institution with a comparison control group. Objective To evaluate the safety of concomitant tethered cord release and growing-rod insertion in individuals with early onset scoliosis. Methods We retrospectively reviewed patients who underwent concurrent tethered cord release and growing-rod insertion. We compared our data to a comparison control group of eight patients who underwent staged tethered cord release and growing-rod insertion. Results We identified three patients meeting criteria. There were no neurological complications in the three patients who underwent concomitant surgery. Average immediate postoperative curve correction was 43.3 degrees (47.6%). We identified seven patients who underwent staged surgery from a multicenter prospective database. No neurological complications were reported, and average immediate postoperative correction was 35.1 degrees (46.2%). Conclusion We believe that concurrent tethered cord release and growing-rod insertion can be performed safely with the use of multimodality neurophysiological monitoring techniques.
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Affiliation(s)
- Jon E. Oda
- Department of Orthopaedic Surgery, Children's Hospital Central California, Madera, California,Department of Orthopedics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Suken A. Shah
- Department of Orthopedics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware,Growing Spine Study Group, La Jolla, California,Address for correspondence and reprint requests Suken A. Shah, MD Nemours/Alfred I. duPont Hospital for Children1600 Rockland RoadWilmington, DE 19899
| | - William G. Mackenzie
- Department of Orthopedics, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Behrooz A. Akbarnia
- Growing Spine Study Group, La Jolla, California,San Diego Center for Spinal Disorders, La Jolla, California
| | - Muharrem Yazici
- Growing Spine Study Group, La Jolla, California,Deptartment of Orthopaedic Surgery, Hacettepe University, Sihhiye, Ankara, Turkey
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Safety and efficacy of 1-stage surgical treatment of congenital spinal deformity associated with split spinal cord malformation. Spine (Phila Pa 1976) 2012; 37:2104-13. [PMID: 22648030 DOI: 10.1097/brs.0b013e3182608988] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective clinical study. OBJECTIVE The aim of this study was to evaluate retrospectively the safety and efficacy of 1-stage surgical treatment of 45 consecutive patients, who had progressive congenital spinal deformity associated with split spinal cord malformation (SSCM). SUMMARY OF BACKGROUND DATA For correction of progressive congenital spinal deformity with SSCM, it has been reported that all SSCM should be operated on before any orthopedic intervention, and then surgery for correction and stabilization of the spinal deformity should be performed 3 to 6 months later. Recently, different viewpoints have been approved, and the common treatment of these 2 associated conditions needs to be re-evaluated. METHODS Patients had 1-stage surgery. After exposure of the determined levels and placement of instruments, bony spur was resected in the patients of type 1; in patients of type 2, we did nothing to the SSCM. In the corrective stage of surgery, posterior fusion surgery was performed in 38 patients; nonfusion surgery was performed in 7 patients. RESULTS Thirty-six female patients and 9 male patients formed the basis of the study. The mean age was 14 years, and the mean follow-up period was 31 months. Type 1 SSCM was in 15 patients, and type 2 SSCM was in 30 patients. Seven patients had progressive neurological deteriorations preoperatively. The mean major curves were corrected from an average of 73.7° to 33.5°, with a correction rate of 54.5%. The overall complication was transient, including 2 patients of neurological compromise and 1 patient of cerebrospinal fluid leakage. The average loss of correction at final follow-up was 2.5° for major curves. CONCLUSION The 1-stage surgical treatment of congenital spinal deformity associated with SSCM provides a satisfactory option to improve the spinal deformity without significant complications effectively. Neurosurgical interventions are recommended to patients with type 1 SSCM before spinal deformity surgery; however, patients with type 2 SSCM can be treated safely without a need of neurosurgical intervention.
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Abstract
The management of pediatric patients with complex spinal deformity often requires both an orthopedic and a neurosurgical intervention. The reasons for multiple subspecialty involvement include, but are not limited to, the presence of a tethered cord requiring release or a syrinx requiring decompression. It has been common practice to perform these procedures in a staged manner, although there is little evidence in the literature to support separate interventions. We reviewed a series of consecutive patients who underwent spinal deformity correction and a neurosurgical intervention concurrently in an attempt to assess the safety, efficacy, and possible complications associated with such an approach. Eleven patients were reviewed who underwent concurrent orthopedic and neurosurgical procedures. Data were collected for patient demographics, preoperative diagnosis, procedures performed, intraoperative and perioperative complications, as well as any unexpected return to the operating room for any reason. Operative notes and anesthesia records were reviewed to determine estimated blood loss, surgical time, and the use of intraoperative neurological monitoring. Patient diagnoses included myelodysplasia (N=6), congenital scoliosis and/or kyphosis (N=4), and scoliosis associated with Noonan syndrome (N=1). Age at the time of surgery averaged 9 years 2 months (range=14 months to 17 years 2 months). Estimated blood loss averaged 605 ml (range=50-3000 ml). The operative time averaged 313 min (range=157-477 min). There were no intraoperative complications, including incidental dural tears or deterioration in preoperative neurological status. One patient developed a sore associated with postoperative cast immobilization that led to a deep wound infection. It appears that concurrent orthopedic and neurosurgical procedures in pediatric patients with significant spinal deformities can be performed safely and with minimal intraoperative and postoperative complications when utilizing modern surgical and neuromonitoring techniques. Level of evidence=Level IV.
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Prevalence of complications in neuromuscular scoliosis surgery: a literature meta-analysis from the past 15 years. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2012; 22:1230-49. [PMID: 23085815 DOI: 10.1007/s00586-012-2542-2] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2012] [Revised: 09/22/2012] [Accepted: 10/02/2012] [Indexed: 12/15/2022]
Abstract
PURPOSE Our objectives were primarily to review the published literature on complications in neuromuscular scoliosis (NMS) surgery and secondarily, by means of a meta-analysis, to determine the overall pooled rates (PR) of various complications associated with NMS surgery. METHODS PubMed and Embase databases were searched for studies reporting the outcomes and complications of NMS surgery, published from 1997 to May 2011. We focused on NMS as defined by the Scoliosis Research Society's classification. We measured the pooled estimate of the overall complication rates (PR) using a random effects meta-analytic model. This model considers both intra- and inter-study variation in calculating PR. RESULTS Systematic review and meta-analysis were performed for 68 cohort and case-control studies with a total of 15,218 NMS patients. Pulmonary complications were the most reported (PR = 22.71 %) followed by implant complications (PR = 12.51 %), infections (PR = 10.91 %), neurological complications (PR = 3.01 %) and pseudoarthrosis (PR = 1.88 %). Revision, removal and extension of implant had highest PR (7.87 %) followed by malplacement of the pedicle screws (4.81 %). Rates of individual studies have moderate to high variability. The studies were heterogeneous in methodology and outcome types, which are plausible explanations for the variability; sensitivity analysis with respect to age at surgery, sample size, publication year and diagnosis could also partly explain this variability. In regard to surgical complications affiliated with various surgical techniques in NMS, the level of evidence of published literature ranges between 2+ to 2-; the subsequent recommendations are level C. CONCLUSION NMS patients have diverse and high complication rates after scoliosis surgery. High PRs of complications warrant more attention from the surgical community. Although the PR of all complications are affected by heterogeneity, they nevertheless provide valuable insights into the impact of methodological settings (sample size), patient characteristics (age at surgery), and continual advances in patient care on complication rates.
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The accuracy of navigation and 3D image-guided placement for the placement of pedicle screws in congenital spine deformity. J Pediatr Orthop 2012; 32:e23-9. [PMID: 22892631 DOI: 10.1097/bpo.0b013e318263a39e] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Treatment of congenital spine deformity has high surgical risk due to abnormal anatomy and dysmorphic pedicles. We hypothesized that an image-guided navigation system would result in a low rate of screw revision due to malposition. METHODS From 2007 to 2010, 142 screws were placed in 14 consecutive patients with congenital spine deformity using an intraoperative computer tomography (CT) (O-arm) and image-guided navigation system (Stealth). Mean age was 8.8 years (range, 1 to 18 y). Deformities included scoliosis (12), kyphosis (1), and spinal dysgenesis (1). Screws were placed from T2 to S1. An intraoperative CT verified screw position. Need for intraoperative screw revision is the primary outcome measure. RESULTS Of the 142 screws placed, 1 required revision intraoperatively due to malposition (99.3% screw accuracy rate). The screw was at L3 and was successfully redirected. There were no complications due to screw malposition. This navigated congenital screw accuracy rate (99.3%) is higher than the 94.9% accuracy rate reported for non-navigated screws in all children undergoing pedicle screw fixation in a recent systematic literature review and higher than the reported 96.4% accuracy rate for navigated pedicle screws in children. Kosmopoulos and colleagues found a lower accuracy rate (86.6%) in adult non-navigated screws (P<0.0001) and adult navigated screws (93.7%). Of note, 9 pedicles were noted on navigation to be absent. Despite the goal of bilateral screw placement at each fusion level, 31 of 173 pedicles were left unfilled due to technical impossibility based on intraoperative CT imaging. This represents an 18% screw dropout rate. CONCLUSIONS CT-guided navigation resulted in the successful placement of 142 pedicle screws in patients with congenital deformity and altered anatomy, which represents a 99.3% screw accuracy rate. This is comparable with the screw accuracy rate of 93.7% reported for adult navigated pedicle screws. Further, navigation prevented attempts of screw placement at levels with absent or impassable pedicles. Image-guided navigation and intraoperative CT are valuable tools for the safe placement of pedicle screws in patients with significant congenital spine deformity and altered anatomy. LEVEL OF EVIDENCE IV, Case Series.
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Short-term X-ray results of posterior vertebral column resection in severe congenital kyphosis, scoliosis, and kyphoscoliosis. Spine (Phila Pa 1976) 2012; 37:1054-7. [PMID: 22024907 DOI: 10.1097/brs.0b013e31823b4142] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective case series. OBJECTIVE To analyze the efficacy and safety of posterior vertebral column resection performed on a consecutive series of patients with severe congenital spinal deformity. SUMMARY OF BACKGROUND DATA The treatment of severe congenital spinal deformities is a demanding and difficult surgical challenge. Conventional procedures, such as posterior and anterior instrumentation or combined anteroposterior instrumentation provide limited correction in rigid neglected or maltreated (fused) deformities. METHODS Forty-four patients with severe deformity and managed by posterior vertebral column resection between years 1997 and 2007 having more than 2 years of follow-up were included. Mean age was 8 (range, 2-28) years at the time of operation. The hospital charts were reviewed for demographic data and etiology of deformity. Measurements of curve magnitude and balance were made on 36-in. standing anteroposterior and lateral radiographs obtained before surgery and at most recent follow-up to assess deformity correction, spinal balance, complications related to the instrumentation, and any evidence of pseudarthrosis. RESULTS Preoperative coronal plane major curve of 106° (range, 90°-132°) with flexibility of less than 30% was corrected to 41.4° (range, 20°-72°), showing a 61% scoliosis correction at the final follow-up. Coronal imbalance was improved by 79% at the most recent follow-up assessment. Preoperative thoracic kyphosis of 87° (range, 67°-103°) in patients with kyphosis was corrected to 36° (range, 25°-48°) at the most recent follow-up evaluation. Lumbar lordosis of 27° (range, 8°-35°) in patients with hypolordotic deformity was corrected to 45°. Complications included postoperative infection in 2 patients, dural laceration in 2 patients, and hemopneumothorax in 1 patient. CONCLUSION Posterior vertebral column resection is an effective technique providing a successful correction of stiff complex congenital deformities. However, it is a technically demanding procedure, with possible risks for major complications.
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Kaspiris A, Grivas TB, Weiss HR, Turnbull D. Surgical and conservative treatment of patients with congenital scoliosis: α search for long-term results. SCOLIOSIS 2011; 6:12. [PMID: 21639924 PMCID: PMC3120793 DOI: 10.1186/1748-7161-6-12] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2010] [Accepted: 06/04/2011] [Indexed: 12/05/2022]
Abstract
Background In view of the limited data available on the conservative treatment of patients with congenital scoliosis (CS), early surgery is suggested in mild cases with formation failures. Patients with segmentation failures will not benefit from conservative treatment. The purpose of this review is to identify the mid- or long-term results of spinal fusion surgery in patients with congenital scoliosis. Methods Retrospective and prospective studies were included, reporting on the outcome of surgery in patients with congenital scoliosis. Studies concerning a small numbers of cases treated conservatively were included too. We analyzed mid-term (5 to 7 years) and long-term results (7 years or more), both as regards the maintenance of the correction of scoliosis and the safety of instrumentation, the early and late complications of surgery and their effect on quality of life. Results A small number of studies of surgically treated patients were found, contained follow-up periods of 4-6 years that in the most cases, skeletal maturity was not yet reached, and few with follow-up of 36-44 years. The results of bracing in children with congenital scoliosis, mainly in cases with failure of formation, were also studied. Discussion Spinal surgery in patients with congenital scoliosis is regarded in short as a safe procedure and should be performed. On the other hand, early and late complications are also described, concerning not only intraoperative and immediate postoperative problems, but also the safety and efficacy of the spinal instrumentation and the possibility of developing neurological disorders and the long-term effect these may have on both lung function and the quality of life of children. Conclusions Few cases indicate the long-term results of surgical techniques, in the natural progression of scoliosis. Similarly, few cases have been reported on the influence of conservative treatment. In conclusion, patients with segmentation failures should be treated surgically early, according to the rate of deformity formation and certainly before the pubertal growth spurt to try to avoid cor- pulmonale, even though there is lack of evidence for that in the long-term. Furthermore, in patients with formation failures, further investigation is needed to document where a conservative approach would be necessary.
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Affiliation(s)
- Angelos Kaspiris
- Department of Trauma and Orthopaedics,"Thriasio" General Hospital - NHS, G, Gennimata av, Magoula 19600, Attica, Greece.
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Outcomes after spinal fusion for congenital scoliosis: instrumented versus uninstrumented spinal fusion. Spine (Phila Pa 1976) 2011; 36:E112-22. [PMID: 21228691 DOI: 10.1097/brs.0b013e3181efaf5c] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN retrospective case-control study. OBJECTIVE to compare radiographic and clinical outcomes in children with congenital scoliosis who had either instrumented or uninstrumented spinal fusion. SUMMARY OF BACKGROUND DATA.: Three previous studies have examined patients with spinal fusion for congenital scoliosis. Two have small case numbers with only short-term follow-up and the third is a large series without clinical outcomes. METHODS after approval from the authors' institutional review board, children who underwent instrumented or uninstrumented spinal fusion for congenital scoliosis were identified. All curves were measured before surgery, after surgery, and annually until final follow-up and the initial postoperative curve correction and the final curve correction were calculated. All patients were sent a Scoliosis Research Society-22 (SRS-22) outcomes instrument to complete at final follow-up. RESULTS a total of 51 subjects were identified. Thirty children were included in the instrumented group and 21 were in the uninstrumented group. For each child, the preoperative curves of the highest magnitude averaged 50° in the instrumented group and 46° in the uninstrumented group. Initial postoperative curve correction averaged 21° in the instrumented group and 4° in the uninstrumented group. At final follow-up, the curves had a mean progression of 10° from initial postoperative Cobb angles in the instrumented group and 8° in the uninstrumented group, or an average of 2° of progression per year from the initial postoperative curve correction in both groups compared with the postoperative curves. The total mean SRS-22 score for the instrumented group was 3.8 ± 0.8 and for the uninstrumented group was 4.1 ± 0.8. There was no difference between the two groups in the categories of function, pain, self-image, mental health, and satisfaction. CONCLUSION we were unable to distinguish between the two groups, using radiographic and clinical (patient-reported) outcome measures except that there was a difference in immediate postoperative curve correction between the two groups. Subjects in both groups showed postoperative curve progression at 2- to 14-year follow-up, but patients reported high-functioning clinical outcomes. LEVEL OF EVIDENCE Therapeutic level III.
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Sudden appearance of new upper extremity motor function while performing neurophysiologic intraoperative monitoring during tethered cord release: a case report. J Pediatr Orthop 2010; 30:624-8. [PMID: 20733431 DOI: 10.1097/bpo.0b013e3181e79041] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
UNLABELLED : Tethered cord syndrome occurs when the distal spinal cord or filum adheres to adjacent structures resulting in progressive sensorimotor deficits in the lower extremities, fecal and/or urinary incontinence, and musculoskeletal deformities. Tethering of the distal cord may be idiopathic, may be associated with an intraspinal abnormality such as a lipoma, but most commonly the distal spinal cord remnant is adherent to the area of the original dysraphism repair in patients with myelodysplasia. Surgery to untether the cord is indicated in patients with worsening pain symptoms, progressive limb deformity or spasticity, or before any acute correction of an associated spinal deformity. Neurophysiologic intraoperative monitoring is used to minimize the risk of inadvertent nerve root or spinal cord injury during the untethering procedure and to assess any changes in cord function at the time of an associated spinal deformity correction. We present a patient with a lumbar level myelodysplasia, Chiari II malformation, severe scoliosis, and tethered cord that underwent concurrent scoliosis correction and tethered cord syndrome surgery, who demonstrated immediate intraoperative improvement in neurophysiologic responses in a previously flaccid upper extremity after untethering. These monitoring changes correlated with clinical improvements noted by physicians and family postoperatively. LEVEL OF EVIDENCE Level IV.
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Pedicle shifting or migration as one of the causes of curve progression after posterior fusion: an interesting case report and review of literature. J Pediatr Orthop B 2009; 18:369-74. [PMID: 19734809 DOI: 10.1097/bpb.0b013e32832f59b0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
The aim of this retrospective study was to explain a previously undescribed mechanism of 'pedicle migration or shift' with longitudinal growth of the spine owing to biological remodeling of plastic posterior fusion mass as well as pedicles which may explain at least a few cases of deformity recurrence after posterior fusion in scoliosis surgery. Progressive loss of deformity correction after scoliosis surgery in growing children has been variously described. The various mechanisms described have been 'crankshaft effect', pseudoarthrosis, implant failure (loosening/breakage), biological plasticity, choosing wrong levels, excessive apical translation causing decompensation by unfused segments, progressive etiology, inadequate anchorage provided by some older instrumentation systems, etc. Though there have been claims that segmental pedicle instrumentation might prevent crankshaft phenomenon by providing a more rigid fixation, numerous studies have shown progressive loss of correction even after segmental pedicle instrumentation. A 10.6-year-old girl was fused posteriorly before her prepubertal growth spurt using segmental screw rod instrumentation. The index case in our study showed progressive loss of operative correction during subsequent follow-up at 2 years. This probably occurred because of longitudinal growth of the spine and posterior fusion mass because of its biological plasticity during the period of rapid growth spurt. In conclusion, despite the recent trend towards the use of segmental pedicle instrumented correction and fusion and claims that by providing rigid, tri-column fixation, it enhances fusion and controls growth of the vertebral body anteriorly; caution must be taken in children with high remaining growth and high growth velocity.
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Is it necessary to operate all split cord malformations before corrective surgery for patients with congenital spinal deformities? Spine (Phila Pa 1976) 2009; 34:2413-8. [PMID: 19829255 DOI: 10.1097/brs.0b013e3181b9c61b] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective case series. OBJECTIVES To evaluate the necessity of neurosurgical interventions for split cord malformations (SCMs) before correction and instrumentation for patients with congenital spinal deformity(CSD)s. SUMMARY OF BACKGROUND DATA SCMs are commonly associated with CSD. As pathology of SCMs understood well, the common belief of all SCM must be operated before any orthopedic intervention is needed to be revised. MATERIALS AND METHODS Sixty-one consecutive patients with CSD and spinal dysraphism treated by correction and posterior instrumentation between 1994 and 2005 were retrospectively evaluated. Inclusion criteria were patients with CSD and SCM, who were treated with long segment instrumentation (more than 6 functional units) with at least 2 years of follow-up. Thirty-two patients (8 male and 24 female) with an age average of 11 years +8 months (4-18 years) fulfilled the criteria. While all patients with Type I SCM were managed with neurosurgical intervention (spur excision and dural reconstruction) before corrective surgery, Type II SCM cases were treated by instrumented fusion without neurologic intervention. RESULTS There were 18 patients with Type I and 14 patients with Type II SCM. The average follow-up was 52 (24-144) months. The correction rate of deformity was 44% in type I and 47% in Type II SCM. Two patients with Type II SCM had transient neurologic deterioration while there were no neurologic events in patients with Type II SCM. CONCLUSION Due to high incidence of SCMs, all patients with CSDs must be evaluated with MRI, before surgery. Neurosurgical interventions are recommended even for neurologically asymptomatic Type I SCM before spinal deformity surgery; however, patients with Type II SCM can be treated safely without a need of neurosurgical intervention.
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Abstract
STUDY DESIGN A retrospective clinical review. OBJECTIVE To review the use of modern instrumentation of the spine for congenital spinal deformities. SUMMARY OF BACKGROUND DATA Spinal instrumentation has evolved since the advent of the Harrington rod. There is a paucity of literature, which discusses the use of modern spinal instrumentation in congenital spine deformity cases. This review focuses on modern instrumentation techniques for congenital scoliosis and kyphosis. METHODS A systematic review was performed of the literature to discuss spinal implant use for congenital deformities. RESULTS Spinal instrumentation may be safely and effectively used in cases of congenital spinal deformity. CONCLUSION Spinal surgeons taking care of children with congenital spine deformities need to be trained in all aspects of modern spinal instrumentation.
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Fusionless instrumentation systems for congenital scoliosis: expandable spinal rods and vertical expandable prosthetic titanium rib in the management of congenital spine deformities in the growing child. Spine (Phila Pa 1976) 2009; 34:1800-7. [PMID: 19644331 DOI: 10.1097/brs.0b013e3181978ec9] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Review of relevant literature including personal opinions. OBJECTIVE To review the current researches investigating the efficacy of growing rod and thoracic expansion techniques in the treatment of congenital spine deformity of young children, and to highlight the contrasting advantages and limitations in the fusionless treatment of progressive congenital scoliosis. SUMMARY OF BACKGROUND DATA Congenital scoliosis has the potential for severe spinal deformity and thoracic insufficiency syndrome (TIS). Conventional fusion treatments in children tend to shorten the spine further exacerbating trunk shortening and TIS. In the surgical treatment of congenital spinal deformities in young children, while reconstructing the spinal deformity, one should simultaneously pursue preserving the growth potential of the vertebrae, improving the volume, symmetry, and functions of the thorax, and protecting this improvement during the growth. Today, employed in the treatment of spinal deformities of young children, there are 2 deformity reconstruction methods serving these targets: Growing rod technique and vertical expandable prosthetic titanium rib (VEPTR) with or without expansion thoracostomy. METHODS Peer-reviewed research articles and major international meeting presentations were reviewed. Methods were compared in terms of advantages and limitations. RESULTS The growing rod technique is a safe and reliable method in the treatment of congenital spine deformity of young children who present some flexibility in the anomalous segment, or when the congenital anomaly involves a vertebral segment too long for resection, or with compensating curve with structural pattern concomitant to the congenital deformity. Expansion thoracostomy and VEPTR are the appropriate choice for severe congenital spine deformity when a large amount of growth remains. Although ventilator dependence is significantly decreasing, thoracic volume and space available for the lung are increased after expansion thoracostomy and VEPTR. CONCLUSION Growing rod technique should be used in patients where the primary problem is at the vertebral column. If the patient has rib fusions and/or TIS has developed, in other words, if the primary problem involves the thoracic cage, expansion thoracostomy and VEPTR should be an appropriate option.
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Weiss HR, Goodall D. Rate of complications in scoliosis surgery - a systematic review of the Pub Med literature. SCOLIOSIS 2008; 3:9. [PMID: 18681956 PMCID: PMC2525632 DOI: 10.1186/1748-7161-3-9] [Citation(s) in RCA: 143] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2008] [Accepted: 08/05/2008] [Indexed: 01/03/2023]
Abstract
Background Spinal fusion surgery is currently recommended when curve magnitude exceeds 40–45 degrees. Early attempts at spinal fusion surgery which were aimed to leave the patients with a mild residual deformity, failed to meet such expectations. These aims have since been revised to the more modest goals of preventing progression, restoring 'acceptability' of the clinical deformity and reducing curvature. In view of the fact that there is no evidence that health related signs and symptoms of scoliosis can be altered by spinal fusion in the long-term, a clear medical indication for this treatment cannot be derived. Knowledge concerning the rate of complications of scoliosis surgery may enable us to establish a cost/benefit relation of this intervention and to improve the standard of the information and advice given to patients. It is also hoped that this study will help to answer questions in relation to the limiting choice between the risks of surgery and the "wait and see – observation only until surgery might be recommended", strategy widely used. The purpose of this review is to present the actual data available on the rate of complications in scoliosis surgery. Materials and methods Search strategy for identification of studies; Pub Med and the SOSORT scoliosis library, limited to English language and bibliographies of all reviewed articles. The search strategy included the terms; 'scoliosis'; 'rate of complications'; 'spine surgery'; 'scoliosis surgery'; 'spondylodesis'; 'spinal instrumentation' and 'spine fusion'. Results The electronic search carried out on the 1st February 2008 with the key words "scoliosis", "surgery", "complications" revealed 2590 titles, which not necessarily attributed to our quest for the term "rate of complications". 287 titles were found when the term "rate of complications" was used as a key word. Rates of complication varied between 0 and 89% depending on the aetiology of the entity investigated. Long-term rates of complications have not yet been reported upon. Conclusion Scoliosis surgery has a varying but high rate of complications. A medical indication for this treatment cannot be established in view of the lack of evidence. The rate of complications may even be higher than reported. Long-term risks of scoliosis surgery have not yet been reported upon in research. Mandatory reporting for all spinal implants in a standardized way using a spreadsheet list of all recognised complications to reveal a 2-year, 5-year, 10-year and 20-year rate of complications should be established. Trials with untreated control groups in the field of scoliosis raise ethical issues, as the control group could be exposed to the risks of undergoing such surgery.
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Affiliation(s)
- Hans-Rudolf Weiss
- Asklepios Katharina Schroth Spinal Deformities Rehabilitation Centre, Korczakstr, 2, D-55566, Bad Sobernheim, Germany.
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