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Yang JH, Chang DG, Suh SW, Kim W, Park J. Clinical and radiological outcomes of hemivertebra resection for congenital scoliosis in children under age 10 years: More than 5-year follow-up. Medicine (Baltimore) 2020; 99:e21720. [PMID: 32769940 PMCID: PMC7593047 DOI: 10.1097/md.0000000000021720] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The surgical treatment of congenital scoliosis under 10 years is difficult as it involves resecting vertebrae. Moreover, patient follow-up after surgery is extremely important because the patient is a child whose growth has not been completed. However, there are very few long-term follow-up studies after surgical treatment of congenital scoliosis. Therefore, this study is designed to evaluate surgical outcomes after posterior hemivertebra resection in children under 10 years and its long-term effects.Twenty-one patients with congenital scoliosis who were younger than 10 years at the time of the surgery and received posterior hemivertebra resection and fusion using pedicle screw fixation were included in this study.There were significant improvements in the main curve, coronal balance, sagittal vertical axis, thoracic kyphosis, and lumbar lordosis after surgery (P < .001, .021, .047, .043, .006, respectively). Coronal balance, sagittal vertical axis, thoracic kyphosis, and lumbar lordosis remained within the normal range during the follow-up period; however, main curve deteriorated significantly (P = .005). Trunk appearance of perception scale improved significantly after surgery (P = .031) and was maintained during the follow-up period (P = .078).In conclusion, posterior hemivertebra resection and fusion using pedicle screw fixation in patients under 10 years old with congenital scoliosis is a safe and effective procedure that can achieve rigid fixation and deformity correction. Complete resection of the hemivertebra is important for deformity correction and prevention of curve progression, and careful long-term follow-up is necessary.
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Affiliation(s)
- Jae Hyuk Yang
- Department of Orthopaedic Surgery, Korea University Guro Hospital, College of Medicine, Korea University
| | - Dong-Gune Chang
- Department of Orthopaedic Surgery, Sanggye Paik Hospital, College of Medicine, Inje University
| | - Seung Woo Suh
- Department of Orthopaedic Surgery, Korea University Guro Hospital, College of Medicine, Korea University
| | - Woon Kim
- Department of Orthopaedic Surgery, Korea University Guro Hospital, College of Medicine, Korea University
| | - Jewel Park
- College of Medicine, Korea University, Seoul, Korea
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Rüwald JM, Eymael RL, Upenieks J, Zhang L, Jacobs C, Pflugmacher R, Schildberg FA. An Overview of the Current State of Pediatric Scoliosis Management. ZEITSCHRIFT FUR ORTHOPADIE UND UNFALLCHIRURGIE 2019; 158:508-516. [PMID: 31416110 DOI: 10.1055/a-0965-7760] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Historically pediatric scoliosis represents a condition deeply rooted within the origins of orthopedic surgery. Today only a few subspecialized surgeons treat pediatric scoliosis patients. In severe cases surgery can hold progression of and correct pathologic spinal curvature. The goal of this article is to provide an overview of the current state of pediatric scoliosis management. It aims to increase the attention of general physicians and orthopedic surgeons to a niched but rather frequently encountered pediatric pathology to facilitate early recognition and diagnosis. A thorough research of literature was conducted to summarize the different scoliosis types, their etiology and presentation. Classification, normal human growth phases and curve progression risk have been further elaborated. Finally, current treatment options with their benefits, shortcomings and complications were laid out and discussed. Among the etiological groups a focus was put on idiopathic scoliosis, in particular adolescent idiopathic scoliosis as the most frequently encountered subtype.
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Affiliation(s)
- Julian M Rüwald
- Clinic for Orthopedics and Trauma Surgery, University Hospital Bonn
| | | | - Janis Upenieks
- Department of Pediatric Surgery, University Children's Hospital, Riga, Latvia
| | - Li Zhang
- Clinic for Orthopedics and Trauma Surgery, University Hospital Bonn
| | - Cornelius Jacobs
- Clinic for Orthopedics and Trauma Surgery, University Hospital Bonn
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Connell B, Oore JJ, Pahys JM, Thompson GH, St Hilaire T, Flynn T, El-Hawary R. Growth-Friendly Surgery Is Effective at Treating Early-Onset Scoliosis Associated With Goldenhar Syndrome. Spine Deform 2019; 6:327-333. [PMID: 29735145 DOI: 10.1016/j.jspd.2017.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 11/12/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the radiographic results and complications of growth-friendly (GF) surgery in the treatment of early-onset scoliosis (EOS) associated with Goldenhar syndrome. BACKGROUND Goldenhar syndrome has been associated with spinal deformity, which may be progressive. Efficacy and complication rate of GF treatment has not been reported for this population of patients with EOS. METHODS Patients with Goldenhar syndrome and EOS with two years' follow-up were identified from two international multicenter EOS databases. Scoliosis, kyphosis, spine height, and hemithoracic height/width were determined preimplant, immediately postoperative, and at the two-year follow-up. Severity of complications (SV) was recorded (Smith et al. JPO 2015). RESULTS Ten patients met inclusion criteria and had a mean age of 4.6 ± 2.5 years at GF implantation (one spine and nine rib-based). Mean preoperative scoliosis was 64°, postimplant 52°, and at mean follow up of 2.4 ± 0.5 years was 50° (p = .09). Preoperative kyphosis was 36°, postimplant 38°, and final 42° (p = .08). Preoperative T1-S1 height was 23.5 cm, postimplant 23.6 cm, and final 27.3 cm (p = .06). Preoperative convex hemithoracic height was 10.4 cm, postimplant 7.9 cm, and final 12.8 cm (p < .05). Preoperative concave hemithoracic height was 8.4 cm, postimplant 8.8 cm, and final 9.9 cm (p = .30). Preoperative right hemithoracic width was 8.02 cm, postimplant 7.22 cm, and final 7.86 cm (p = .07). Preoperative left hemithoracic width was 7.18 cm, postimplant 7.86 cm, and final 8.60 cm (p = .43). Eight patients had ≥1 complication with SV I (n = 7), SV II (n = 2), and SV IIA (n = 7). These included infection (n = 4), migration (n = 3), pneumonia (n = 2), and instrumentation failure (n = 2). CONCLUSION At minimum two-year follow-up, GF surgical intervention for the treatment of EOS associated with Goldenhar syndrome trended toward improvements in scoliosis and spine height, but had a significant improvement in convex hemithoracic height; however, the majority of patients experienced severity grade I or II complications. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Braydon Connell
- Department of Medicine, Dalhousie University, 6299 South St, Halifax, NS B3H 4R2, Canada; IWK Health Centre, 5980 University Ave, Halifax, NS B3K 6R8, Canada.
| | - Jonathan J Oore
- Department of Medicine, Dalhousie University, 6299 South St, Halifax, NS B3H 4R2, Canada; IWK Health Centre, 5980 University Ave, Halifax, NS B3K 6R8, Canada
| | - Joshua M Pahys
- Shriner's Hospital, 3551 N Broad St, Philadelphia, PA 19140, USA
| | - George H Thompson
- Rainbow Babies and Children's Hospital, 11100 Euclid Ave, Cleveland, OH 44106, USA
| | - Tricia St Hilaire
- Children's Spine Foundation, P.O. Box 397, Valley Forge, PA 19481, USA
| | - Tara Flynn
- Children's Spine Foundation, P.O. Box 397, Valley Forge, PA 19481, USA
| | - Ron El-Hawary
- Department of Medicine, Dalhousie University, 6299 South St, Halifax, NS B3H 4R2, Canada; IWK Health Centre, 5980 University Ave, Halifax, NS B3K 6R8, Canada
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Zhou PL, Poorman GW, Wang C, Pierce KE, Bortz CA, Alas H, Brown AE, Tishelman JC, Janjua MB, Vasquez-Montes D, Moon J, Horn SR, Segreto F, Ihejirika YU, Diebo BG, Passias PG. Klippel-Feil: A constellation of diagnoses, a contemporary presentation, and recent national trends. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2019; 10:133-138. [PMID: 31772424 PMCID: PMC6868534 DOI: 10.4103/jcvjs.jcvjs_65_19] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Klippel–Feil syndrome (KFS) includes craniocervical anomalies, low posterior hairline, and brevicollis, with limited cervical range of motion; however, there remains no consensus on inheritance pattern. This study defines incidence, characterizes concurrent diagnoses, and examines trends in the presentation and management of KFS. Methods: This was a retrospective review of the Kid's Inpatient Database (KID) for KFSpatients aged 0–20 years from 2003 to 2012. Incidence was established using KID-supplied year and hospital-trend weights. Demographics and secondary diagnoses associated with KFS were evaluated. Comorbidities, anomalies, and procedure type trends from 2003 to 2012 were assessed for likelihood to increase among the years studied using ANOVA tests. Results: Eight hundred and fifty-eight KFS diagnoses (age: 9.49 years; 51.1% females) and 475 patients with congenital fusion (CF) (age: 8.33 years; 50.3% females) were analyzed. We identified an incidence rate of 1/21,587 discharges. Only 6.36% of KFS patients were diagnosed with Sprengel's deformity; 1.44% with congenital fusion. About 19.1% of KFS patients presented with another spinal abnormality and 34.0% presented with another neuromuscular anomaly. About 36.51% of KFS patients were diagnosed with a nonspinal or nonmusculoskeletal anomaly, with the most prevalent anomalies being of cardiac origin (12.95%). About 7.34% of KFS patients underwent anterior fusions, whereas 6.64% of KFS patients underwent posterior fusions. The average number of levels operated on was 4.99 with 8.28% receiving decompressions. Interbody devices were used in 2.45% of cases. The rate of fusions with <3 levels (7.46%) was comparable to that of 3 levels or greater (7.81%). Conclusions: KFS patients were more likely to have other spinal abnormalities (19.1%) and nonnervous system abnormalities (13.63%). Compared to congenital fusions, KFS patients were more likely to have congenital abnormalities such as Sprengel's deformity. KFS patients are increasingly being treated with spinal fusion. Level of Evidence: III
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Affiliation(s)
- Peter L Zhou
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Brooklyn, NY, USA
| | - Gregory W Poorman
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Brooklyn, NY, USA
| | - Charles Wang
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Brooklyn, NY, USA
| | - Katherine E Pierce
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Brooklyn, NY, USA
| | - Cole A Bortz
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Brooklyn, NY, USA
| | - Haddy Alas
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Brooklyn, NY, USA
| | - Avery E Brown
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Brooklyn, NY, USA
| | - Jared C Tishelman
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Brooklyn, NY, USA
| | | | - Dennis Vasquez-Montes
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Brooklyn, NY, USA
| | - John Moon
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Brooklyn, NY, USA
| | - Samantha R Horn
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Brooklyn, NY, USA
| | - Frank Segreto
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Brooklyn, NY, USA
| | - Yael U Ihejirika
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Brooklyn, NY, USA
| | - Bassel G Diebo
- Department of Orthopaedic Surgery, Suny Downstate Medical Center, Brooklyn, NY, USA
| | - Peter Gust Passias
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, Brooklyn, NY, USA
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Passias PG, Poorman GW, Vasquez-Montes D, Wang C, Jalai C, Horn SR, Steinmetz LM, Bortz CA, Segreto FA, Moon J, Zhou PL, Diebo BG, Vira S. Cluster analysis describes constellations of cardiac anomalies presenting in spinal anomaly patients. Acta Neurochir (Wien) 2018; 160:1613-1619. [PMID: 29956035 DOI: 10.1007/s00701-018-3596-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 06/11/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Cardiac anomalies are prevalent in patients with bony spinal anomalies. Prior studies evaluating incidences of bony congenital anomalies of the spine are limited. The Kids' Inpatient Database (KID) yields national discharge estimates of rare pediatric conditions like congenital disorders. This study utilized cluster analysis to study patterns of concurrent vertebral anomalies, anal atresia, cardiac malformations, trachea-esophageal fistula, renal dysplasia, and limb anomalies (VACTERL anomalies) co-occurring in patients with spinal congenital anomalies. METHODS Retrospective review of KID 2003-2012. KID-supplied hospital- and year-adjusted weights allowed for incidence assessment of bony spinal anomalies and cardiac, gastrointestinal, urinary anomalies of VACTERL. K-means clustering assessed relationships between most frequent anomalies within bony spinal anomaly discharges; k set to n - 1(n = first incidence of significant drop/little gain in sum of square errors within clusters). RESULTS There were 12,039,432 KID patients 0-20 years. Incidence per 100,000 discharges: 2.5 congenital fusion of spine, 10.4 hemivertebra, 7.0 missing vertebra. The most common anomalies co-occurring with bony vertebral malformations were atrial septal defect (ASD 12.3%), large intestinal atresia (LIA 11.8%), and patent ductus arteriosus (PDA 10.4%). Top congenital cardiac anomalies in vertebral anomaly patients were ASD, PDA, and ventricular septal defect (VSD); all three anomalies co-occur at 6.6% rate in this vertebral anomaly population. Cluster analysis revealed that of bony anomaly discharges, 55.9% of those with PDA had ASD, 34.2% with VSD had PDA, 22.9% with LIA had ASD, 37.2% with ureter obstruction had LIA, and 35.5% with renal dysplasia had LIA. CONCLUSIONS In vertebral anomaly patients, the most common co-occurring congenital anomalies were cardiac, renal, and gastrointestinal. Top congenital cardiac anomalies in vertebral anomaly patients were ASD, PDA, and VSD. VACTERL patients with vertebral anomalies commonly presented alongside cardiac and renal anomalies.
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Lin S, Shi S, Zhou Y, Ji Y, Huang P, Wu J, Chen B, Luo Y. Intrauterine phenotypic features associated with 16p11.2 recurrent microdeletions. Prenat Diagn 2018. [PMID: 29514395 DOI: 10.1002/pd.5245] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To investigate the detection rate of 16p11.2 recurrent microdeletions in fetuses with abnormal ultrasound findings and determine the common abnormal ultrasound findings in fetuses carrying the deletion. METHODS This study reviewed 2262 consecutive fetuses with abnormal ultrasound findings who underwent prenatal chromosomal microarray analysis between October 2014 and December 2016. Cases carrying the 16p11.2 recurrent microdeletion were further genetically analyzed, and their clinical features were reviewed. RESULTS The 16p11.2 recurrent microdeletion was identified in 12 fetuses, who had skeletal malformations (5/12), cardiovascular malformations (4/12), or isolated ultrasound markers (3/12). Approximately 0.5% (12/2262) of the fetuses with abnormal ultrasound findings harbored the deletion. The 5 fetuses with skeletal malformations displayed vertebral defects, particularly in the hemivertebra and butterfly vertebra. The detection rate of the 16p11.2 recurrent microdeletion was statistically significant (P < .05) among fetuses with skeletal malformations (3.6%, 5/140), fetuses with cardiovascular malformations (1.1%, 4/367), and fetuses with isolated ultrasound markers (0.4%, 3/702). CONCLUSION The most frequent ultrasound findings in fetuses with 16p11.2 recurrent microdeletions are skeletal malformations (particularly vertebral malformations), followed by cardiovascular malformations, and isolated ultrasound markers.
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Affiliation(s)
- Shaobin Lin
- Fetal Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Shanshan Shi
- Fetal Medicine Center, The First Affiliated Hospital, Jinan University, Guangzhou, People's Republic of China
| | - Yi Zhou
- Fetal Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Yuanjun Ji
- Fetal Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Peizhi Huang
- Fetal Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Jianzhu Wu
- Fetal Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Baojiang Chen
- Fetal Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Yanmin Luo
- Fetal Medicine Center, Department of Obstetrics and Gynecology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, People's Republic of China
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Stokes IA. Spinal Deformity in Vitamin D-Deprived Pigs: Why and What Next?: Commentary on an article by Matthew A. Halanski, MD, et al.: "Maternal Diets Deficient in Vitamin D Increase the Risk of Kyphosis in Offspring. A Novel Kyphotic Porcine Model". J Bone Joint Surg Am 2018; 100:e33. [PMID: 29509629 DOI: 10.2106/jbjs.17.01345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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GUIMARÃES NILZANASCIMENTO, PINHEIRO JÚLIOCESARCALDAS, VASCONCELOS UBIRATANMAIARODRIGUESDE, MENDONÇA CAROLINARODRIGUESDE. COSTAL MALFORMATION RELATED TO THORACOLUMBAR SCOLIOSIS IN ADOLESCENTS - CASE REPORT. COLUNA/COLUMNA 2018. [DOI: 10.1590/s1808-185120181701175991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Congenital scoliosis associated with costal malformation is well known. However, there are no reports of idiopathic scoliosis associated with the fusion of the costal arcs in the literature. This report describes a case of idiopathic scoliosis with fusion of the 1st and 2nd costal arches in a female patient and reports changes in the deformity due to scoliosis because of the treatment. The analysis was performed from a morphological and clinical point of view, and by complementary tests. Radiographs and CT scans were obtained and evaluated from the first consultation in 2012 and during the period in which the patient was followed in a private clinic, until the stabilization of the condition, in 2014. The evolution was favorable with the use of a Milwaukee vest and there was improvement of the clinical picture after the skeletal maturity, and the angle of lateral curvature, measured by the Cobb method, initially of 20 degrees, was reduced and stabilized in nine degrees, measure which is currently maintained. The analysis showed concomitant pathologies, and the fusion of costal arches did not influence the spine deformity, since there was regression with the clinical treatment. This evolution leads us to conclude that adolescent idiopathic scoliosis should be imputed as the sole responsible for the clinical picture of the patient, and that the fusion of the costal arches does not interfere with the biomechanics of the spine. Level of Evidence: IV. Type of study: Case series.
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Pseudarthrosis in adult and pediatric spinal deformity surgery: a systematic review of the literature and meta-analysis of incidence, characteristics, and risk factors. Neurosurg Rev 2018; 42:319-336. [PMID: 29411177 DOI: 10.1007/s10143-018-0951-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 01/18/2018] [Accepted: 01/25/2018] [Indexed: 01/11/2023]
Abstract
We conducted a systematic review with meta-analysis and qualitative synthesis. This study aims to characterize pseudarthrosis after long-segment fusion in spinal deformity by identifying incidence rates by etiology, risk factors for its development, and common features. Pseudarthrosis can be a painful and debilitating complication of spinal fusion that may require reoperation. It is poorly characterized in the setting of spinal deformity. The MEDLINE, EMBASE, and Cochrane databases were searched for clinical research including spinal deformity patients treated with long-segment fusions reporting pseudarthrosis as a complication. Meta-analysis was performed on etiologic subsets of the studies to calculate incidence rates for pseudarthrosis. Qualitative synthesis was performed to identify characteristics of and risk factors for pseudarthrosis. The review found 162 articles reporting outcomes for 16,938 patients which met inclusion criteria. In general, the included studies were of medium to low quality according to recommended reporting standards and study design. Meta-analysis calculated an incidence of 1.4% (95% CI 0.9-1.8%) for pseudarthrosis in adolescent idiopathic scoliosis, 2.2% (95% CI 1.3-3.2%) in neuromuscular scoliosis, and 6.3% (95% CI 4.3-8.2%) in adult spinal deformity. Risk factors for pseudarthrosis include age over 55, construct length greater than 12 segments, smoking, thoracolumbar kyphosis greater than 20°, and fusion to the sacrum. Choice of graft material, pre-operative coronal alignment, post-operative analgesics, and sex have no significant impact on fusion rates. Older patients with greater deformity requiring more extensive instrumentation are at higher risk for pseudarthrosis. Overall incidence of pseudarthrosis requiring reoperation is low in adult populations and very low in adolescent populations.
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Abstract
BACKGROUND Progress in medical branches that has taken place since the first child with Goldenhare syndrome (GS) had been described in 1952 by Maurice Goldenhar, facilitated better understanding of this congenital defect. It also gave new perspectives and the opportunity to achieve satisfactory treatment results, mainly due to development of surgical techniques. DATA SOURCES Based on the literature and own experience, we discussed the phenotype of presentation of GS, ethiopathogenesis, genetic counselling and treatment with particular emphasis on surgery correction of hemifacial microsomia. RESULTS The spectrum of GS abnormalities ranges from mild to severe ones and include patients with barely noticeable facial asymmetry to very pronounced facial defect with more or less severe abnormalities of internal organs and/or skeleton. It is characterized most commonly by impaired development of eyes, ears, lips, tongue, palate, mandible, maxilla, zygomatic and orbital structures and deformations of the teeth structures. Ethiopathogenesis is multifactorial and dependent on genetic and environmental factors but there are still many unknowns about the syndrome which should be revealed. CONCLUSIONS Patients with GS due to a large variety of abnormalities and different severity of symptoms pose a challenge for clinicians. All of this necessitate an individual approach to each single patient and involvement a team of specialists in treatment planning. It is a complex, long-lasting, multidisciplinary process and should be divided into stages, according to patient's age, as well as the extent and severity of observed abnormalities. Neonatologists and pediatricians are involved in care of these patients from the onset.
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Li S, Ou Y, Liu B, Zhu Y, Quan Z, Jiang D. Comparison of osteotomy versus non-osteotomy approach for congenital scoliosis: a retrospective study of three surgical techniques. ANZ J Surg 2014; 85:249-54. [PMID: 25316619 PMCID: PMC4409081 DOI: 10.1111/ans.12886] [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] [Accepted: 09/01/2014] [Indexed: 12/01/2022]
Abstract
Background Currently, there are many reports about congenital scoliosis (CS) treatment, but there are still controversies existing with respect to selecting its surgical methods. Methods Retrospective analyses were conducted on 31 CS patients. The surgical treatments included the following: posterior instrumentation (10 patients; group 1), pedicle subtraction osteotomy (11 patients; group 2) and vertebral column resection (10 patients; group 3). Results All patients had remarkable improvements in morphology, image findings, visual analogue scale and American Spinal Injury Association classification. Groups 2 and 3 had greater preoperative sagittal Cobb's angle (25.0, 62.2 and 9.2°, respectively), greater intra-operative blood loss (604.5, 620.0 and 460.0 mL, respectively) and fewer fused segments (5.8, 6.3 and 9.2, respectively) than group 1. As compared with group 1, groups 2 and 3 had greater correction rate of coronal Cobb's angle (79.6 ± 12.8, 78.2 ± 10.1% versus 56.1 ± 11.1%), and coronal trunk inclination (77.6 ± 14.2, 85.2 ± 11.0% versus 45.0 ± 42.5%). The sagittal Cobb's angle correction rates of three groups were 67.7 ± 42.9, 79.3 ± 27.6, 84.3 ± 12.1%, respectively, which showed no significant difference (P = 0.461). With an average follow-up of 3.5, 3.2 and 4.0 years, the correction loss rate of coronal Cobb's angle in group 1 was higher than those of groups 2 and 3. Conclusion For CS patients, osteotomy procedure had less fused segments, along with a greater correction rate and lower correction loss, which were more advantageous for those with severe deformity in sagittal plane or nerve decompression requirements.
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Affiliation(s)
- Shenghua Li
- Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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12
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Paoletti D, Robertson M, Sia SB. A sonographic approach to prenatal classification of congenital spine anomalies. Australas J Ultrasound Med 2014; 17:20-37. [PMID: 28191204 PMCID: PMC5024920 DOI: 10.1002/j.2205-0140.2014.tb00081.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Objective: To develop a classification system for congenital spine anomalies detected by prenatal ultrasound. Methods: Data were collected from fetuses with spine abnormalities diagnosed in our institution over a five-year period between June 2005 and June 2010. The ultrasound images were analysed to determine which features were associated with different congenital spine anomalies. Findings of the prenatal ultrasound images were correlated with other prenatal imaging, post mortem findings, post mortem imaging, neonatal imaging, karyotype, and other genetic workup. Data from published case reports of prenatal diagnosis of rare congenital spine anomalies were analysed to provide a comprehensive work. Results: During the study period, eighteen cases of spine abnormalities were diagnosed in 7819 women. The mean gestational age at diagnosis was 18.8w ± 2.2 SD. While most cases represented open NTD, a spectrum of vertebral abnormalities were diagnosed prenatally. These included hemivertebrae, block vertebrae, cleft or butterfly vertebrae, sacral agenesis, and a lipomeningocele. The most sensitive features for diagnosis of a spine abnormality included flaring of the vertebral arch ossification centres, abnormal spine curvature, and short spine length. While reported findings at the time of diagnosis were often conservative, retrospective analysis revealed good correlation with radiographic imaging. 3D imaging was found to be a valuable tool in many settings. Conclusions: Analysis of the study findings showed prenatal ultrasound allowed detection of disruption to the normal appearances of the fetal spine. Using the three features of flaring of the vertebral arch ossification centres, abnormal spine curvature, and short spine length, an algorithm was devised to aid with the diagnosis of spine anomalies for those who perform and report prenatal ultrasound.
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Affiliation(s)
- Debra Paoletti
- Fetal Medicine Unit Division of Women Youth and Children Canberra Hospital Garran Australian Capital Territory Department of Obstetrics and Gynaecology Australian National University Acton Australian Capital Territory Australia
| | - Meiri Robertson
- Fetal Medicine Unit Division of Women Youth and Children Canberra Hospital Garran Australian Capital Territory Department of Obstetrics and Gynaecology Australian National University Acton Australian Capital Territory Australia
| | - Sock Bee Sia
- Discipline of Medical Radiations School of Medical Sciences RMIT University Melbourne Victoria Australia
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Hui H, Zhang ZX, Yang TM, He BR, Hao DJ. Vertebral column resection for complex congenital kyphoscoliosis and type I split spinal cord malformation. 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 2013; 23:1158-63. [PMID: 24232596 DOI: 10.1007/s00586-013-3044-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2013] [Revised: 09/12/2013] [Accepted: 09/24/2013] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Congenital progressive kyphoscoliosis associated with split spinal cord malformation (SSCM) is a very rare disease. METHODS AND RESULTS Here, we present the case of a 23-year-old woman who was found kyphoscoliosis when she was 10 years old and developed rapidly. Thereafter, no management was proposed before her consultation at our center. On examination, numbness was found in the right low limbs, kyphoscoliosis was detected in thoracolumbar, the trunk deviated to the right on standing view and curvature of the thoracolumbar spine was left-sided, the left rib hump was severe and there was little muscle tissue felt under the right side paravertebral area, the pelvis was oblique with the right side higher than the left side, the right arcus costarum was 5 cm below the right iliac crest. One-stage corrective surgery was determined, at first, halo-wheelchair traction gradually with increased traction weights out of hospital for a month; then, after a reasonable correction achieved without any neurological deficits. The one-stage operation was taken through single posterior segmental pedicle screw instrumented fusion with VCR between T12 and L1. Post-operative recovery was uneventful and there were no complications, she was discharged 10 days post operation. At 2 years follow-up, the patient's outcome is excellent with balance and correction of the deformity. CONCLUSION Based on the Grand Round case and relevant literature, we discuss the different options for the treatment of congenital kyphoscoliosis associated with type I SSCM. In the patient whose kyphoscoliosis is severe and rigid, we recommend an initial release followed by halo-wheelchair traction gradually to correct the deformity, once optimal correction acquires during the traction, the posterior instrumented fusion with VCR upper the bony spur could be done safely without the resection of bony spur.
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Chhabra A, Arora MK, Baidya DK, Talawar P, Singh PM, Jayswal A. Perioperative concerns in pediatric patients u10/1/2013ndergoing different types of scoliosis correction surgery: A retrospective observational study. J Anaesthesiol Clin Pharmacol 2013; 29:323-7. [PMID: 24106355 PMCID: PMC3788229 DOI: 10.4103/0970-9185.117072] [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] [Indexed: 11/21/2022] Open
Abstract
Background: Advances in scoliosis surgery have now made it possible for younger patients to be taken up for scoliosis correction. Objectives: To ascertain the patient profile, perioperative complications and need for intensive care management in children undergoing posterior fusion and instrumentation (PF), anterior release (AR), and growth rod (GR) insertion surgery. Patients and Methods: After taking parental consent, data were collected retrospectively for 33 patients who underwent 37 procedures (four patients had both anterior and posterior procedures) on 2 days of the week mainly from August 2008 to February 2010 at a tertiary care institution. Results: Children undergoing GR surgery were younger (8.1 ± 2.1 years) than patients undergoing AR (12.9 ± 1.7 years) or posterior fusion (14.2 ± 2.2 years). AR children had a significantly higher Cobb's angle and more rigid curves. (P = 0.057) Associated congenital abnormalities especially neurological were commoner in the GR children. Surgical duration and blood loss was significantly more for PF (2207.5 ± 1224.13 ml) than GR (456 ± 337.5 ml), or AR (642.85 ± 304.72 ml), (P = 0.0002). PF patients needed Intensive care unit (ICU) care mainly due to the blood loss and prolonged surgery (35%). AR performed via thoracotomy was associated with the need for mechanical ventilation in 28.6%. The GR patients had major intraoperative hemodynamic events and 20% needed ICU care. Conclusions: Post-operative ventilation may be required in 20-35% patients undergoing procedures for scoliosis correction. Despite GR insertion involving lesser blood loss; younger age, congenital abnormalities, positioning, and surgical manipulation resulted in life threatening events in these patients.
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Affiliation(s)
- Anjolie Chhabra
- Department of Anaesthesiology and Intensive Care, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
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Chatterjee AD, Hassan K, Grevitt MP. Congenital kypho-scoliosis: a case of thoracic insufficiency syndrome and the limitations of treatment. 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 2011; 21:1043-9. [PMID: 22048403 DOI: 10.1007/s00586-011-2032-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Revised: 07/03/2011] [Accepted: 09/16/2011] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Congenital spinal vertebral anomalies may present with deformity resulting in congenital scoliosis and kyphosis. This leads to abnormal spinal growth. The latter when combined with associated rib fusions may impair normal thoracic cage development and resultant pulmonary hypoplasia. Most congenital scoliosis can be detected in utero by ultrasound scan or recognized in the neonatal period, but a few spinal defects can remain undetected. MATERIALS AND METHODS In this Grand Round, we present the case of a 7-year-old girl with a severe scoliosis and thoracic insufficiency syndrome (TIS). 3D CT reconstruction imaging demonstrated a mixed picture of fusion and segmentation abnormalities. A marked kyphoscoliosis was demonstrated at the thoraco-lumbar junction. Via a left thoracotomy, anterior excision of intervertebral discs was performed together with, interbody fusion, and in situ stabilisation of the kyphosis with double allograft (femur) strut grafts. CONCLUSIONS This article highlights the features of congenital kypho-scoliosis and TIS. The difficulties of treating kyphosis when combined with TIS are discussed together with the limitations of current surgical techniques.
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Affiliation(s)
- A D Chatterjee
- Centre for Spinal Studies and Surgery, Queens Medical Centre, Derby Road, Nottingham, UK.
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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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