Cases reported "Scoliosis"

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1/15. 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.
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2/15. Acute lower gastrointestinal bleeding as a late complication of spinal instrumentation.

    Posterior or anterior fusion with spinal instrumentation is a well-known operation for scoliosis. There are multiple potential complications; the most common are blood loss during the initial surgery and wound infection. Vascular injury has been reported. However, to the authors' knowledge, acute gastrointestinal bleeding has not been reported. The authors report on a child who presented 6 years after posterior spinal instrumentation with massive acute lower gastrointestinal bleeding resulting from internal iliac artery injury and bowel perforation. The etiology, diagnosis, and management of such bleeding is reviewed.
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keywords = blood loss
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3/15. Spinal deformity associated with carbohydrate-deficient glycoprotein syndrome (Jaeken's syndrome): a report of three cases.

    STUDY DESIGN: case reports are presented. OBJECTIVE: To report the association between carbohydrate-deficient glycoprotein syndrome Type 1a (CDGS Type 1a) and spinal deformity. SUMMARY OF BACKGROUND DATA: Carbohydrate-deficient glycoprotein syndrome Type 1a is an autosomal recessive metabolic disorder that may occur in association with spinal deformity. methods: Analyses of three cases are presented, including a review of the natural history of the disease. RESULTS: Three cases were reviewed in which spinal deformities developed in patients with CDGS Type 1a. Two patients required surgical correction of their spinal deformity, and one patient, at this writing, is undergoing conservative treatment. Before surgery, the pediatric hematology service was consulted regarding the patients' CDGD-related hypercoagulability. Of the two patients who underwent surgical correction, one had severe blood loss (7500 mL), and both cases were treated for infection via intravenous antibiotics. CONCLUSIONS: The incidence of CDGS Type 1a is 1 in 80,0000. Spinal deformity appears to be common in patients with CDGS Type 1a. Therefore, young patients with spinal deformities in combination with mental retardation, failure to thrive, abnormal fat distribution, and other symptoms of CDGS Type 1a should be assessed for this disorder, and patients with CDGS Type 1a should be screened also for spinal deformities. If abnormalities are identified early, treatment outcomes may be optimized.
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keywords = blood loss
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4/15. Strategies for managing decreased motor evoked potential signals while distracting the spine during correction of scoliosis.

    Surgical correction of kyphoscoliosis may result in spinal cord injury and neurologic deficits. Monitoring somatosensory evoked potentials (SSEPs) and transcranial motor evoked potentials (MEPs) intraoperatively may allow for early detection and reversal of spinal cord injury. Controlled hypotension and isovolemic hemodilution are often used during these cases to reduce blood loss and transfusion. However, these physiologic parameters may affect the quality of SSEP and MEP signals. Acute reduction or loss of MEP or SSEP signals during spinal distraction presents a crisis for the operative team: should distraction be immediately relieved? The authors describe three patients who showed a decrease in evoked potential signals under hypotensive, hemodiluted conditions at the stage of spinal distraction. Each case illustrates a different strategy for successful management of these patients.
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ranking = 1
keywords = blood loss
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5/15. Visual field defect after posterior spine fusion.

    STUDY DESIGN: Case report and literature review. OBJECTIVES: review cases and literature regarding visual loss following posterior spine fusion for scoliosis and emphasize right-to-left atrial shunt as a risk factor for paradoxical embolus resulting in a postoperative visual field defect. SUMMARY OF BACKGROUND DATA: The existing literature discusses various possible etiologies of postoperative visual loss including direct pressure, hypotension, blood loss, and anemia. One study shows higher rates of cerebral microemboli in patients with right-to-left atrial shunts. methods: Chart and literature review. RESULTS: A paradoxical embolus to a branch of the central retinal artery resulted in a unilateral quadrant defect (homonymous quadrantanopsia) in a girl with a previously undiagnosed right-to-left atrial shunt. CONCLUSIONS: Right-to-left atrial shunts may predispose to cerebral emboli during scoliosis surgery. These emboli may be a cause of postoperative visual field defects.
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ranking = 1
keywords = blood loss
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6/15. Increased blood loss during posterior spinal fusion for idiopathic scoliosis in an adolescent with Fontan physiology.

    A 15-year-old patient with Fontan physiology experienced major blood loss during posterior spinal fusion for idiopathic scoliosis. Contributing factors for the increased blood loss and potentially useful measures to limit blood loss in patients with Fontan physiology are discussed.
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ranking = 7
keywords = blood loss
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7/15. Surgical correction of developmental scoliosis following cardiac transplantation: case report.

    STUDY DESIGN: Case report. OBJECTIVE: To present a pediatric patient who underwent successful 2-stage anterior and posterior scoliosis surgery 20 months after cardiac transplantation. SUMMARY OF BACKGROUND DATA: Cardiac transplantation has increased the life expectancy in children with end-stage cardiac failure caused by congenital heart disease or cardiomyopathy. scoliosis is commonly associated with congenital cardiac disease. Previous reports have suggested that anterior scoliosis surgery is contraindicated after heart transplantation. methods: We describe the case of a 13-year-old patient who underwent staged anterior and posterior spinal arthrodesis to correct a severe thoracic developmental scoliosis. RESULTS: The 2 procedures were performed 1 week apart. Following the first stage, pulmonary edema had developed, which required reintubation and administration of diuretics. Significant blood loss occurred during the posterior spinal fusion. The patient had a satisfactory correction of her scoliosis and made a good recovery. Three years after surgery, she had no complaints of her back and had a solid spinal fusion. CONCLUSIONS: Elective anterior and posterior spinal arthrodesis can be safely performed in cardiac transplant recipients with severe developmental scoliosis. This procedure can achieve optimum correction of the curvature and a successful outcome without long-term medical or technical complications.
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ranking = 1
keywords = blood loss
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8/15. spinal fusion surgery in children with non-idiopathic scoliosis: is there a need for routine postoperative ventilation?

    BACKGROUND: The perioperative management of children with non-idiopathic scoliosis undergoing spinal deformity surgery has not been standardized and the current practice is to routinely ventilate these patients in the postoperative period. This study reports the experience from a single institution and evaluates the need and reasons for postoperative ventilation. Details of ventilated patients are presented. methods: All patients undergoing spinal fusion surgery for non-idiopathic scoliosis were recorded prospectively (2003-4). patients were anaesthetized according to a standardized technique. Physical characteristics, cardiopulmonary function, intraoperative blood loss and fluid requirement, postoperative need for ventilation and all perioperative adverse events were recorded on a computer database. RESULTS: A total of 76.2% of patients were safely extubated at the end of surgery without any further complications or need for re-ventilation; 23.8% of patients required postoperative ventilation with half of the cases being planned before operation and 40% of all patients with Duchenne muscular dystrophy (DMD) required postoperative ventilation. There were no specific factors that could predict the need for postoperative ventilation, although an increased tendency for children with DMD and those with a preoperative forced vital capacity <30% towards requiring postoperative ventilation was observed. CONCLUSIONS: Early extubation can be safely performed after spinal deformity surgery for non-idiopathic scoliosis. The use of short-acting anaesthetics, drugs to reduce blood loss, experienced spinal anaesthetists and the availability of intensive care support are all essential for a good outcome in patients with neuromuscular disease and cardiopulmonary co-morbidity.
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ranking = 2
keywords = blood loss
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9/15. Anaesthesia and rett syndrome: a case report.

    rett syndrome is a neurological disorder of females characterized by dementia, autism, movement disorders and an abnormality of respiratory control. A 14-year-old girl with rett syndrome underwent spinal fusion surgery under general anaesthesia. No exacerbation of the respiratory control defect with surgery and anaesthesia was observed. hypothermia, ongoing blood loss and a normal anion gap acidosis were encountered, but were not attributable to features of this disorder.
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ranking = 1
keywords = blood loss
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10/15. hemodilution and induced hypotension for insertion of a Harrington rod in a Jehovah's Witness patient.

    The case of a 28-year-old Jehovah's Witness illustrates the feasibility of using a combined technique of induced hypotension and hemodilution to minimize the surgical loss of red blood cells during the insertion of a Harrington rod. A Swan-Ganz catheter with thermister tip was inserted to measure pulmonary arterial pressure, pulmonary arterial wedge pressure and cardiac output. Other intraoperative monitoring included continuous arterial pressure, electrocardiography, oropharyngeal temperature, esophageal stethoscope, arm-cuff blood pressure and urinary output from an indwelling Foley catheter. A total of 10 L of crystalloid was infused over a 2 1/2-hour period while hypotension was induced by intravenous nitroprusside and enflurane anesthesia. hematocrit was diluted from 46% to 26% intraoperatively with an estimated surgical blood loss of 2,740 ml. The 24-hour postoperative hematocrit was 30% and recovery was uneventful. This method may be useful in any orthopedic procedure in which heavy blood loss is anticipated and the patient refuses transfusion of blood or blood products. However, the patient must be in good health and have an uncompromised cardiopulmonary system.
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ranking = 2
keywords = blood loss
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