Cases reported "Kyphosis"

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1/13. Transpedicular eggshell osteotomies for congenital scoliosis using frameless stereotactic guidance.

    STUDY DESIGN: Three cases of multiplanar congenital scoliosis corrected by a transpedicular eggshell osteotomy using frameless stereotactic guidance are reported. OBJECTIVE: To show an alternative surgical technique for correcting and fusing complex congenital spinal curves. SUMMARY OF BACKGROUND DATA: Children with congenital scoliosis can have progressive curves causing significant multiplanar deformities. In older children, traditional approaches to spinal corrective surgery including fusion in situ, convex growth arrest, and hemivertebra excision can achieve only limited corrections. methods: Three older patients who had congenital scoliosis with significant multiplanar curves underwent one-stage posterior transpedicular eggshell osteotomy. Three-dimensional reconstructive images and frameless stereotactic guidance were used for preoperative selection of osteotomy levels and accurate placement of pedicle screws. After completion of the osteotomy, closure was obtained with extension of the hips. RESULTS: The average coronal correction of the major curve was 28.7 degrees (range, 22-33 degrees ). The average correction of the plumb line or lateral displacement from the center of the trunk was 4.8 cm (range, 3-7.5 cm). A significant kyphotic deformity was corrected 38 degrees, and a pelvic tilt was reduced from 7 to 3 cm. CONCLUSIONS: One-stage posterior reduction eggshell osteotomy can be used to correct a sagittal and/or coronal congenital spinal curve imbalance. Frameless stereotactic guidance for solid pedicle screw fixation was essential to the achievement of rigid spinal stabilization before arthrodesis. Transpedicular eggshell osteotomy is a technique that should be considered for older patients who have congenital scoliosis with multiplanar spinal abnormalities.
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2/13. Use of vascularized fibular grafts as a salvage procedure for previously failed spinal arthrodesis.

    STUDY DESIGN: A case series of spinal arthrodesis performed with vascularized fibular grafts is presented. OBJECTIVES: The use of vascularized fibular grafts to obtain anterior spinal fusion in patients with complex spinal disorders and poor fusion environments is described. SUMMARY OF BACKGROUND DATA: The fusion success of spinal arthrodesis is dependent on numerous factors, such as the substrate used for arthrodesis (i.e., graft), the biology of the fusion bed, and local host factors. Vascularized grafts have higher success rates for union and can better overcome a poor fusion bed than nonvascular grafts. However, they are associated with higher donor site morbidity and greater technical difficulty. methods: Three patients with complex medical histories portending a difficult spinal fusion were treated with anterior arthrodesis using vascularized fibular autografts. vascular patency was confirmed by bone scintigraphy, and osseous union by radiography and computed tomography. RESULTS: All patients had successful osseous fusion in 3 to 6 months. Deformity was improved. patients reported decreased pain and resumption to previous activities at 24 months follow-up. There were no complications. CONCLUSIONS: A vascularized fibular graft is a useful alternative to standard grafts for spinal arthrodesis. Vascularized fibular grafts provide high fusion rates, rapid incorporation, and increased mechanical strength, and thus heal better in a suboptimal graft bed. The procedure is technically demanding, often requiring the expertise of a microvascular surgeon for obtaining the graft and achieving anastomosis. It is best suited in cases where significant difficulty in obtaining a spinal fusion is anticipated.
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3/13. Lateral approach for resection of the C3 corpus: technical case report.

    OBJECTIVE AND IMPORTANCE: The C3 level is the transition zone between the upper and lower cervical spine. Because of its high position and anatomic relationships to significant structures, exposing C3 is challenging, and the surgical approach is controversial. CLINICAL PRESENTATION: A 16-year-old girl was admitted to our institution with a 3-year history of neck pain and progressive quadriparesis. Neuroradiological examination revealed severe spinal cord compression from kyphosis at the C3 level. TECHNIQUE: We used the lateral approach to resect the C3 corpus and realign the cervical spine. Resecting the transverse processes of C2-C4 and mobilizing the V2 segment of the vertebral artery adequately exposed C3 for resection. Bilateral occipitocervical fusion was performed in a second procedure, and no postoperative complications occurred. The patient's neurological status improved drastically after surgery, and she has had no craniocervical instability during the follow-up period. CONCLUSION: The lateral approach to the C3 corpus offers the greatest degree of cord decompression and easy access to the lesion in a wide and sterile operative field. We describe the surgical technique of this approach as an alternative to the anterior transmucosal or anterolateral retropharyngeal approach.
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4/13. Bilateral split latissimus dorsi V-Y flaps for closure of large thoracolumbar meningomyelocele defects.

    Closure of large meningomyelocele wounds and defects always requires durable and safe coverage of the dural repair. A new technical method for the reconstruction of large thoracolumbar meningomyelocele defects is described in which bilateral musculocutaneous flaps are advanced and transposed medially in a V-Y sliding manner, based on the thoracolumbar perforatiors of the latissimus dorsi. This procedure provides a reliable, well-vascularized soft tissue coverage over the neural repair with minimum donor-site morbidity. Additionally, this method is particularly appropriate to the thoracolumbar area, as it preserves the lateral adjacent regions of the defect, for later alternative and/or reconstructive options.
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5/13. chiropractic management of ehlers-danlos syndrome: a report of two cases.

    OBJECTIVE: To discuss 2 patients with ehlers-danlos syndrome seeking chiropractic evaluation and management of their disabling musculoskeletal pain and associated disorders. CLINICAL FEATURES: Two disabled patients diagnosed with Ehlers-Danlos syndrome had spinal pain, including neck and back pain, headache, and extremity pain. Commonalities among these 2 cases included abnormal spinal curvatures (kyphosis and scoliosis), joint hypermobility, and tissue fragility. One patient had postsurgical thoracolumbar spinal fusion (T11-sacrum) for scoliosis and osteoporosis. The other patient had moderate anterior head translation. INTERVENTION AND OUTCOME: Both patients were treated with mechanical force and manually assisted spinal adjustments delivered to various spinal segments and extremities utilizing an Activator II Adjusting Instrument and Activator methods chiropractic Technique. patients were also given postural advice, stabilization exercises, and postural corrective exercises, as indicated in chiropractic biophysics Technique protocols. Both patients were able to reduce pain and anti-inflammatory medication usage in association with chiropractic care. Significant improvement in self-reported pain and disability as measured by visual analog score, Oswestry Low-Back Disability Index, and neck pain Disability Index were reported, and objective improvements in physical examination and spinal alignment were also observed following chiropractic care. Despite these improvements, work disability status remained unchanged in both patients. CONCLUSION: chiropractic care may be of benefit to some patients with connective tissue disorders, including ehlers-danlos syndrome. Low-force chiropractic adjusting techniques may be a preferred technique of choice in patients with tissue fragility, offering clinicians a viable alternative to traditional chiropractic care in attempting to minimize risks and/or side effects associated with spinal manipulation. Psychosocial issues, including patient desire to return to work, were important factors in work disability status and perceived outcome.
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6/13. Balloon kyphoplasty for treatment of sacral insufficiency fractures. Report of three cases.

    Sacral insufficiency fracture is a painful injury, for which no effective treatment currently exists. The objective of this study was to report on the clinical outcomes and technical aspects of balloon kyphoplasty, which was used in three patients with this injury. Three elderly women with intractable pain from sacral insufficiency fractures were treated with polymethyl methacrylate (PMMA) injections into the sacrum by using a modified balloon kyphoplasty procedure. The visual analog scale pain score improved by four points in each case. Functional status was improved and analgesic medication requirements were decreased in all three patients. There were no complications associated with the procedure. Because of the unique anatomy of the sacrum, it was difficult to monitor instrument placement and PMMA injection by using conventional fluoroscopy. BrainLAB image guidance was used in one case, and was helpful in guiding instrument placement and assuring accurate PMMA deposition at the fracture site. Balloon kyphoplasty may be a treatment alternative in selected patients with sacral insufficiency fractures. BrainLAB image guidance may offer some advantages over conventional fluoroscopy with regard to the monitoring of instrument placement and PMMA injection.
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7/13. Management of difficult intubation in a patient with ankylosing spondylitis--a case report.

    We describe a case of difficult intubation in a patient suffering from ankylosing spondylitis undergoing total hip replacement surgery. The anesthetic management of 42 year old patient with difficult airway is discussed. Failure of epidural anesthesia procedure necessitated general anesthesia. The problems of performing awake fibreoptic intubation and other alternative techniques to secure the airway are described. Cervical spine involvement in ankylosing spondylitis is of great concern for the anesthetist. Longstanding progressive course of this disease leads to fibrosis, ossification and ankylosis of entire spine and sacroiliac joints. Cervical spine mobility is decreased and in severe cases total fixity occurs in a flexed position. Patient may also have atlanto-occipital and temporo-mandibular joint involvement as well. Cricoarytenoid cartilages involvement may result in upper airway compromise. Furthermore cervical spine vertebrae are prone to fractures, especially on hyperextension and may lead to spinal cord transection and quadriplegia. In this case report we describe the airway management of such patient with fixed rigidity of cervical spine and thoracolumbar kyphosis.
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8/13. Anterior vascular rib pedicle graft and posterior instrumentation in tuberculous spondylitis. A case report.

    A technique of anterior decompression and vascular rib pedicle graft with second-stage posterior instrumentation and fusion is presented as an alternative method in the treatment of tuberculous spondylitis. A case is reported to illustrate the results.
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9/13. Anterior vascular pedicle bone grafting for the treatment of kyphosis.

    A technique of anterior strut grafting for the management of kyphosis is presented. The procedure consists of rotating a rib on its intact intercostal blood supply and then keying it in over the appropriate length of spine to be fused. This technique appears to be an attractive alternative to an avascular rib or fibula allograft where a graft fracture may develop during the process of bony consolidation.
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10/13. Successful establishment of pregnancy by superovulation and intrauterine insemination with sperm recovered by a modified Hotchkiss procedure from a patient with retrograde ejaculation.

    OBJECTIVE: To improve the quality of the sperm recovered from the bladder in a patient with retrograde ejaculation who already had failed to conceive after several attempts at IUI with sperm recovered by conventional techniques. SETTING: University Hospital. patients: A couple with male infertility due to retrograde ejaculation caused by the Zielke operation, a spinal fixation procedure performed to correct severe kyphoscoliosis. INTERVENTION: superovulation and IUI of sperm recovered from the bladder using a modified Hotchkiss procedure involving the introduction into the bladder of Earle's balanced salt solution (EBSS) buffered with hepes in sufficient quantity to bring the urinary pH and osmolarity to those of fresh ejaculate. MAIN OUTCOME MEASURES: urine pH and osmolarity at baseline and after dilution with EBSS buffered with hepes. Concentration, motility, and progression score of the sperm recovered from the bladder. RESULTS: Good sperm samples were achieved. pregnancy was established when IUI was performed in association with superovulation induction. CONCLUSIONS: Determination of urine pH and osmolarity appears to be a useful method for choosing the ideal sperm recovery procedure. The modified Hotchkiss procedure described seems to be a promising alternative method for recovering sperm for artificial insemination.
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