1/393. Shortening of a unit rod protruding into the hip joint: case report and description of a surgical technique.A unit rod is a well-accepted method of posterior spinal instrumentation in patients with cerebral palsy (CP). Several types of complications after the use of a unit rod were reported, including penetration through the medial wall of the pelvis. A patient who underwent anterior and posterior spinal fusion with unit-rod instrumentation was found to have penetration of the unit rod into a dysplastic hip joint. The pelvic limb of the rod was shortened with a burr through an anterolateral approach to the iliac bone. This procedure was associated with a lower blood loss than was previously reported for revisions of unit rods. There was no need for hardware removal and therefore no loss of correction. The unit rod may be shortened before surgery to prevent this problem. The described procedure is a simple way of correcting penetration of a unit-rod limb into the hip joint.- - - - - - - - - - ranking = 1keywords = spinal (Clic here for more details about this article) |
2/393. Pediatric syringomyelia with chiari malformation: its clinical characteristics and surgical outcomes.BACKGROUND: Most reports regarding pediatric syringomyelia have focused not only on Chiari malformation, but also on spinal dysraphism. However, the clinical characteristics of syringomyelia with spinal dysraphism are quite different from those of syringomyelia due to Chiari Type I malformation. The objectives of this study were to identify clinical characteristics of pediatric syringomyelia and to determine whether surgery prevents or corrects the scoliosis associated with syringomyelia. methods: We reviewed the records of 16 pediatric patients with syringomyelia and Chiari Type I malformation. The patients' ages ranged from 3 to 15 years, with mean age of 9.8 years. None of the patients had spinal dysraphism. RESULTS: Nystagmus was observed in 2 of the 16 patients, motor weakness in 8 patients, sensory disturbance in 10 patients, and scoliosis in 13 patients. As the initial surgical procedure, foramen magnum decompression (FMD) was performed in seven patients and syringo-subarachnoid (S-S) shunting in nine patients. The motor function improved in 7 of the 8 affected patients, and the sensory disturbance improved in 9 of the 10 affected patients. The magnetic resonance images obtained after the surgery revealed marked decrease of the syrinx size in all patients. Of the 13 patients with scoliosis, 5 showed improvement, 5 stabilization, and 3 deterioration. CONCLUSIONS: Compared with adolescent and adult syringomyelia, pediatric syringomyelia shows a much lower incidence of sensory disturbance and pain, but quite a high incidence of scoliosis. Surgery is effective in improving or stabilizing scoliosis in these patients.- - - - - - - - - - ranking = 1.5keywords = spinal (Clic here for more details about this article) |
3/393. Ischio-spinal dysostosis: a previously unrecognised combination of malformations.BACKGROUND: Ischial hypoplasia is an extremely rare malformation, both as an isolated anomaly and as a syndromic constituent. OBJECTIVE: To elucidate the clinical and radiological characteristics in five patients with the combination of ischial hypoplasia and spinal malformations. MATERIALS AND methods: The clinical records and radiographs of two females and three males, ranging in age from 3 months to 38 years, were evaluated. RESULTS: Ossification defects of the ischial rami were symmetrical and total in four patients, whereas the right ischial ramus was partly ossified in the other patient. All patients possessed multiple segmental defects of the spine, with rib anomalies of varying severity. One patient characteristically showed multiple rib gaps, resulting in respiratory distress. Severe anomalies of the cervical spine were evident in two patients. Four patients exhibited lumbosacral hypoplasia, which ultimately led to cauda equina syndrome in three older patients. One patient had mild facial dysmorphism and another had a diversity of anomalies, including ichthyosiform skin changes. Four patients were sporadic cases, whereas the other patient was born to consanguineous parents. CONCLUSIONS: The combination of anomalies in these patients constitutes a recognisable pattern of malformations but may represent a heterogeneous group of disorders.- - - - - - - - - - ranking = 2.5keywords = spinal (Clic here for more details about this article) |
4/393. The importance of an intact abdominal musculature mechanism in maintaining spinal sagittal balance. Case illustration in prune-belly syndrome.STUDY DESIGN: A rare case of thoracic hypokyphotic deformity secondary to prune-belly syndrome is presented. OBJECTIVES: To discuss the role of an intact abdominal musculature mechanism in maintaining spinal sagittal balance, and to present a case illustration of prune-belly syndrome. SUMMARY OF BACKGROUND DATA: There has been an ongoing debate concerning the integrity of the abdominal musculature unit in maintaining spinal support and stability. It is now believed that intra-abdominal pressure hitherto generated plays an important role in the stabilization of the spine. Congenital aplasia of the abdominal musculature, termed prune-belly syndrome, might therefore result in the loss of spinal function and stability. The literature also is reviewed for the incidence of spinal deformities related to this condition. methods: A unique case of prune-belly syndrome in a 33-year-old man with congenital aplasia of the abdominal musculature is presented. RESULTS: The patient exhibited loss of the spinal sagittal balance, with resultant development of a thoracic hypokyphotic deformity and thoracolumbar scoliosis. CONCLUSIONS: scoliosis appears to be the most commonly reported spinal deformity. Unequal compressive forces on the vertebral endplates may be the proposed mechanism for the spinal deformities. Compensatory lumbar paraspinal overactivity resulting from the inability to generate normal intra-abdominal pressures because of a deficient abdominal wall musculature mechanism seems to be the plausible explanation for the observed thoracic hypokyphatic deformity.- - - - - - - - - - ranking = 6keywords = spinal (Clic here for more details about this article) |
5/393. External iliac artery occlusion in posterior spinal surgery.STUDY DESIGN: Report of a case of external iliac artery occlusion occurring as a rare complication of lumbar posterior spinal surgery. OBJECTIVE: To clarify the cause of this rare complication and recommend methods for preventing its recurrence. SUMMARY OF BACKGROUND DATA: Several cases of central retinal artery occlusion after posterior spinal surgery have been reported, but there has been no reported case of external iliac artery occlusion after posterior spinal surgery. methods: A 65-year-old woman who had a 32-year history of systemic lupus erythematosus underwent posterior decompression and spinal fusion for degenerative scoliosis. She was supported on a Hall frame during the operation. Three hours after surgery, paralysis and sensory impairment of the left leg and cyanosis of the toes of the left foot were noted. The popliteal, dorsalis pedis, and posterior tibial pulses were not palpable. angiography showed complete occlusion of the external iliac artery, and emergency removal of the thrombus was performed. RESULTS: One year later, neurologic symptoms were absent, and the leg vessels were normal. CONCLUSIONS: Prolonged direct pressure on the inguinal region during posterior spinal surgery on a Hall frame may cause external iliac artery occlusion. Early recognition and adequate treatment can prevent serious sequelae.- - - - - - - - - - ranking = 4.5keywords = spinal (Clic here for more details about this article) |
6/393. Surgical treatment of poliomyelitic scoliosis.Between 1968 and 1973 forty nine patients suffering from poliomyelitic scoliosis were treated surgically at the Rizzoli Institute. They were due to asymmetrical paralysis and contracture in the muscles of the trunk and limbs. Associated pathological conditions were found, such as pelvic obliquity, and vascular and trophic changes due to ganglionic lesions. The differing incidence and combination of these factors gave rise to various clinical types of spinal deformity. The average severity of curve was 39 degrees, the localisation was predominantly central, the average extent was ten vertebrae, and there was a marked predominance of right convexity (twenty nine out of thirty six). The rate of progression was maximum during puberty and almost negligible after bony maturity. It was greater in males and was unfavourably affected by the severity and asymmetrical distribution of the paralysis, by the early appearance of the disease, by high localisation of the deformity, and by the erect posture in patients who were ambulant. The most frequent visceral complications were in the respiratory system (ten patients with a deficit over 50%), followed by cardiac changes. Surgical treatment was adopted in patients with progressive curves over 60 degrees, because of the inevitable deterioration in their general condition and the tendency of the deformity to become fixed. Pre-operative correction by Halo-traction results (52% correction) than Risser plasters (38%). Posterior arthrodesis by Harrington's method was carried out in all the more recent cases (forty four). Post-operative plaster was maintained for eight months and then replaced by an orthopaedic corset. At bony maturity there was an averaged improvement of 35% in the angle of curvature, and an average improvement of 6% in vital capacity. The best corrections were obtained in patients under fourteen (42%), in dorso-lumbar scoliosis (40%) and in patients with curves above 100 degrees (38%). There was an average increase in height of 9.1 cms and a reduction in the gibbus of 3.4 cms. The complications included one traumatic pneumothorax, eight pseudarthroses, and breakage of the distraction rod in two cases resulting in complete relapse of the deformity. In six cases the upper hooks became loos and there were two cases of postoperative staphylococcal infection. In the distally sited curves our present policy is towards combining posterior arthrodesis with Dwyer's anterior interbody fusion.- - - - - - - - - - ranking = 0.5keywords = spinal (Clic here for more details about this article) |
7/393. Unusual presentation of spinal cord compression related to misplaced pedicle screws in thoracic scoliosis.Utilization of thoracic pedicle screws is controversial, especially in the treatment of scoliosis. We present a case of a 15-year-old girl seen 6 months after her initial surgery for scoliosis done elsewhere. She complained of persistent epigastric pain, tremor of the right foot at rest, and abnormal feelings in her legs. Clinical examination revealed mild weakness in the right lower extremity, a loss of thermoalgic discrimination, and a forward imbalance. A CT scan revealed at T8 and T10 that the right pedicle screws were misplaced by 4 mm in the spinal canal. At the time of the revision surgery the somatosensory evoked potentials (SSEP) returned to normal after screw removal. The clinical symptoms resolved 1 month after the revision. The authors conclude that after pedicle instrumentation at the thoracic level a spinal cord compression should be looked for in case of subtle neurologic findings such as persistent abdominal pain, mild lower extremity weakness, tremor at rest, thermoalgic discrimination loss, or unexplained imbalance.- - - - - - - - - - ranking = 3keywords = spinal (Clic here for more details about this article) |
8/393. Intramedullary spinal teratoma and diastematomyelia. Case report and review of the literature.The authors present a patient with diastematomyelia and a spinal intramedullary teratoma, remote from the split cord malformation. A split cord malformation at the L2-L3 level was initially discovered during investigations for thoracic congenital scoliosis, and this was treated surgically. The teratoma, which was at the level of the scoliosis, went undiagnosed until neurological deterioration occurred many years later. Surgical removal of the teratoma resulted in return to normal function. The potential for coexisting congenital anomalies at separate levels of the spinal cord must be considered in radiological investigations of a developmental spinal lesion.- - - - - - - - - - ranking = 3.5keywords = spinal (Clic here for more details about this article) |
9/393. A case of ventricular fibrillation in the prone position during back stabilisation surgery in a boy with Duchenne's muscular dystrophy.A 15-year-old boy with Duchenne's muscular dystrophy experienced prolonged cardiac arrest whilst in the prone position for spinal surgery. He was successfully resuscitated without apparent neurological sequelae by internal cardiac massage via a thoracotomy and external and internal direct current cardioversion. Recommendations are suggested for the pre- and peroperative management of such cases.- - - - - - - - - - ranking = 0.5keywords = spinal (Clic here for more details about this article) |
10/393. Efficacy of intraoperative monitoring for pediatric patients with spinal cord pathology undergoing spinal deformity surgery.STUDY DESIGN: A retrospective study of 38 pediatric patients with spinal cord pathology who underwent corrective spinal deformity surgery from January 1989 through June 1998. OBJECTIVES: To report reliability and specificity in obtaining intraoperative data in this population. These data were compared with monitoring results obtained in a group of pediatric patients with idiopathic scoliosis. SUMMARY OF BACKGROUND DATA: Reports in the literature suggest intraoperative monitoring for patients with spinal cord pathology may be of limited value. No optimal monitoring protocol has been suggested for this population. methods: The study group consisted of 38 pediatric patients with a diagnosis of spinal cord pathology who underwent corrective spinal deformity surgery from January 1989 through June 1998. All patients had lower extremity function. Somatosensory and neurogenic motor evoked potentials were used to monitor neurologic status during surgery. These data were compared with data obtained in 429 pediatric patients with idiopathic scoliosis. Study patients were divided into Group I, those who had had spinal cord surgery (n = 20), and Group II, those who had not (n = 18). RESULTS: Somatosensory evoked potentials were obtained in 93.2% and remained consistent with baselines in 87.2% of the study group patients. Neurogenic motor evoked potentials were obtained in 50.8% of the study subjects and remained consistent in 76.6% of those cases. The false-positive rate was 27.1% in the study group, compared with 1.4% in the group with idiopathic scoliosis. The study group had no true-positive or false-negative findings. Group I data differed from Group II data. CONCLUSIONS: Intraoperative monitoring should be used in patients with spinal cord pathology who undergo surgery for spinal deformity. Monitoring should not miss a neurologic deficit but demonstrates greater variability, resulting in more frequent use of an intraoperative wake-up test.- - - - - - - - - - ranking = 8keywords = spinal (Clic here for more details about this article) |
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