Cases reported "Cerebral Palsy"

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1/44. Computer modeling of the pathomechanics of spastic hip dislocation in children.

    Spastic muscles about the hip cause subluxation, dislocation, and lead to acetabular dysplasia. Spastic hip disease occurs when the muscles about the hip exert forces that are too high or in the wrong direction or both. To determine the role of the hip forces in the progression of spastic hip disease and the effect of both muscle-lengthening and bony reconstructive surgeries, a computerized mathematical model of a spastic hip joint was created. The magnitude and direction of the forces of spastic hips undergoing surgery were analyzed preoperatively and postoperatively to determine which procedure is best suited for the treatment of spastic hip disease. The muscle-lengthening procedures included (a) the adductor longus, (b) the psoas, iliacus, gracilis, adductor brevis, and adductor longus, and (3) the psoas, iliacus, gracilis, adductor brevis, adductor longus, semimembranosus, and semitendinosus. The bony reconstructive and muscle-lengthening procedures included (a) lengthening the psoas, iliacus, gracilis, adductor brevis, adductor longus, semimembranosus, and semitendinosus combined with changing femoral neck anteversion from 45 to 10 degrees , (b) lengthening of the psoas, iliacus, gracilis, adductor brevis, adductor longus, semimembranosus, and semitendinosus combined with changing neck-shaft angle from 165 to 135 degrees , and (c) lengthening of the psoas, iliacus, gracilis, adductor brevis, adductor longus, semimembranosus, and semitendinosus combined with changing femoral neck anteversion from 45 to 10 degrees and neck-shaft angle from 165 to 135 degrees . Results show that a child with spastic hip disease has a hip-force magnitude 3 times that of the a child with a normal hip in the normal physiologic position. Based on this mathematical model the best to normalize the magnitude of the hip-joint reaction force, the muscles to be lengthened should include the psoas, iliacus, gracilis, adductor brevis, and the adductor longus. To normalize the direction of the hip force, the extremity should be positioned in the normal physiologic position. The impact of decreasing the femoral anteversion or femoral neck-shaft angle or both had little additional effect on the direction or magnitude of hip forces.
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2/44. Spinal deformity after selective dorsal rhizotomy in patients with cerebral palsy.

    Selective dorsal rhizotomy is used widely as a means of treating spasticity associated with cerebral palsy. Little is known regarding the effect of the procedure on the development or progression of spinal deformity. The authors reviewed six patients with progressive deformity after rhizotomy. Prerhizotomy and postrhizotomy records of physical examinations and radiographs were reviewed retrospectively in an attempt to identify risk factors for development of and/or rapid progression of, spinal deformity. Detailed preoperative and postoperative evaluation of spinal alignment should be undertaken, particularly in those patients who may be at risk of rapidly progressive deformity.
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3/44. Circumferential cervical surgery for spondylostenosis with kyphosis in two patients with athetoid cerebral palsy.

    BACKGROUND: patients with athetoid cerebral palsy may develop severe degenerative changes in the cervical spine decades earlier than their normal counterparts due to abnormal cervical motion. methods: Two patients, 48 and 52 years of age, presented with moderate to severe myelopathy (Nurick Grades IV and V). MR and 3-dimensional CT studies demonstrated severe spondylostenosis with kyphosis in both patients. This necessitated multilevel anterior corpectomy with fusion (C2-C7, C3-C7) using fibula and iliac crest autograft and Orion plating, followed by posterior wiring, fusion using Songer cables, and halo placement. RESULTS: Postoperatively, both patients improved, demonstrating only mild or mild to moderate (Nurick Grades II and III) residual myelopathy. Although both fused posteriorly within 3.5 months, the patient with the fibula graft developed a fracture of the anterior C7 body with mild anterior graft migration, and inferior plate extrusion into the C7-T1 interspace. However, because he has remained asymptomatic for 9 months postoperatively, without dysphagia, removal of the plate has not yet been necessary. CONCLUSIONS: patients with athetoid cerebral palsy should undergo early prospective cervical evaluations looking for impending cord compromise. When surgery is indicated, circumferential surgery offers the maximal degree of cord decompression and stabilization with the highest rate of fusion.
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4/44. Induction of general anesthesia using propofol for cesarean section of a woman with cerebral palsy.

    A 45-year-old pregnant woman with cerebral palsy was scheduled for cesarean section at 37 weeks' gestation due to the risk of athetotic reaction. Spinal anesthesia appeared difficult to perform due to maintenance position, and because maternal respiratory depression due to athetotic reaction to mechanical stimulation might cause fetal hypoxia. We therefore selected general anesthesia. propofol and succinylcholine were intravenously (i.v.) administered for induction, and additional propofol was administered i.v. for hemodynamics stabilization. Neonatal Apgar scores were 8 at one minute and 10 at five minutes. No maternal respiratory depression was observed postoperatively, and a healthy baby was successfully delivered.
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5/44. Spontaneous ankylosis of the contralateral hip after unilateral adductor tenotomy in cerebral palsy.

    This is the case report of a 15-year-old black male with spastic quadriplegia cerebral palsy who developed heterotopic ossification and spontaneous ankylosis of his contralateral nonoperative hip after unilateral adductor tenotomy. To the authors' knowledge, this is the only reported case of such an occurrence. The mechanism and possible risk factors are discussed as well as management of this complication.
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6/44. Postoperative stroke in a child with cerebral palsy heterozygous for factor v Leiden.

    A 5-year-old with spastic quadraparetic cerebral palsy suffered multiple strokes after extensive orthopedic surgery. Coagulation testing was undertaken to determine whether a familial thrombophilia was present. The patient was found to be heterozygous for factor v Leiden. factor v Leiden may be a risk factor for central nervous system events in special-needs children, particularly when common medical conditions create additional procoagulant risks.
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keywords = operative
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7/44. Isolated thoracolumbar and lumbar hyperlordosis in a patient with cerebral palsy.

    A severe isolated thoracolumbar and lumbar hyperlordosis spinal deformity occurring in a patient with cerebral palsy is rare and has not been reported before. The authors describe the presentation, operative considerations, and treatment of patients with this unusual hyperlordotic spinal deformity, particularly those with cerebral palsy. A multiple-stage surgical reconstruction was required to correct this complex spinal deformity. The patient underwent bilateral femoral extension osteotomies along with spinal extensor myotomies to ensure proper prone positioning for his anticipated spinal surgery. Then he had staged anterior releases and spinal fusion from T8 to the sacrum followed by 2 weeks of "90-90" femoral skeletal traction. Finally, a posterior spinal fusion with instrumentation from T2 to the pelvis definitively corrected his deformity. The patient responded well to surgical intervention without complications and continues to have stable correction of his hyperlordosis deformity 2 years after surgery. Severe lordotic sagittal plane spinal deformities can be treated with anterior and posterior spinal fusion and instrumentation with intervening traction in the properly selected and prepared patient who has cerebral palsy.
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8/44. Effect of surgery on the nontreated hip in severe cerebral palsy.

    We studied the fate of the nonoperated hip in 35 patients with cerebral palsy who underwent surgical stabilization for unilateral hip subluxation (24 patients) or dislocation (11 patients). review of medical records and radiographs was performed and analysis was accomplished on the effect of preoperative and radiographic variables on the radiographic outcome of the nonoperated hip. The average age at surgery was 5.5 years and at follow-up was 9.7 years, with an average follow-up of 4.2 years. Before subsequent surgery (in 15 nonoperated hips) or at follow-up, 10 of the nonoperated hips were dislocated and 16 hips were subluxated. Hips were stable and less likely to have surgery if they had a lower initial migration index and higher center edge angles. We conclude that there are few indications for unilateral hip surgery in patients with diplegia or quadriplegia undergoing initial hip stabilization surgery, especially if any degree of dysplasia is present.
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9/44. Division of C8 nerve root for treatment of spastic cerebral palsy in the upper limbs: a preliminary report.

    OBJECTIVE: To investigate the effect of C8 nerve root division on the treatment of spastic cerebral palsy in the upper limbs. methods: Two patients were treated with division of the C8 never root. Supraclavicular incision was made to expose the C5-T1 nerve roots. The intraoperative electromyographic recording technique was used to monitor the responses from the flexor digitorum and flexor carpi ulnaris muscle groups simultaneously. The C5-T1 nerve roots were stimulated and the evoked muscle amplitude potentials (EMAP) were recorded from the muscle groups. The EMAP of the muscle groups obtained during electrical stimulation of the C8 nerve root was the largest, which was used as the basis for C8 nerve root division. RESULTS: Division of the C8 nerve root slightly affected the function of the upper limb, and reduced the muscle tone of the flexor wrist and digitorum. CONCLUSION: Division of the C8 nerve root can reduce the muscle tone of the flexor wrist and digitorum in a short time. The long-term effects need to be followed up further.
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10/44. Where there's hope.

    A young patient's account of her preoperative and postoperative experiences is recalled.
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