Cases reported "Scoliosis"

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1/8. Stress fracture of the hip and pubic rami after fusion to the sacrum in an adult with scoliosis: a case report.

    Correction of adult scoliosis frequently involves long segmental fusions, but controversy still exists whether these fusions should include the sacrum. It has been suggested that forces associated with activities of daily living transfer the stresses to the remaining levels of the spine and to the pelvis. The case described here was a 43-year-old woman with scoliosis and chronic back pain refractory to non-surgical modalities. Radiographically, the patient had a 110 degree lumbar curve. An anterior and posterior fusion with Luque-Galveston instrumentation was performed. Six months postoperatively the patient returned with a 2-week history of right hip pain with no history of trauma. There was radiographic evidence of a displaced femoral neck fracture and pubic rami fractures. The femoral neck fracture was treated with a total hip replacement. Further surgeries were required to correct a lumbar pseudoarthrosis and hardware failure. We believe that this case provides evidence that fusion into the lumbosacral junction may distribute forces through the pelvic bones and hip resulting in stress and potential hardware complications, especially in patients at risk due to osteopenic conditions.
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keywords = sacrum
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2/8. 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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keywords = sacrum
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3/8. The pros and cons to saving the L5-S1 motion segment in a long scoliosis fusion construct.

    STUDY DESIGN: This is a review of the literature and personal experience as it pertains to whether a long fusion should be stopped at L5 or S1 in a patient with adult lumbar scoliosis and degenerative changes. OBJECTIVES: To summarize the problems with decision-making and to point out the strengths and limitations of past studies. SUMMARY OF BACKGROUND DATA: There is a paucity of data on this subject. Problems with stopping at L5 include fixation at that segment and subsequent breakdown at L5-S1. The problems with stopping at the sacrum include the additional surgical requirements and increased potential for pseudarthrosis. methods: Summarized is past literature and, to some extent, personal experience of the author(s). RESULTS: There are situations where it is clearly preferable to stop at the sacrum. However, there are many borderline circumstances in which whether it is better to stop at L5 or the sacrum is not clear cut. CONCLUSIONS: The answer to this question requires further study. Multicenter data collection, consistency of approach, and potential randomization in a prospective fashion might help provide an answer.
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keywords = sacrum
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4/8. spondylolysis after spinal instrumentation in osteogenesis imperfecta.

    spondylolysis occurred distal to spinal instrumentation and fusion to a lower lumbar level in a patient with osteogenesis imperfecta. Initial extension to the sacrum may avoid this complication in patients with a weakened spinal column.
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keywords = sacrum
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5/8. A study of pressure distributions measured during balanced and unbalanced sitting.

    An instrument that measures pressures distribution during normal and unbalanced sitting was developed and tested. Analysis of the distribution of pressure during sitting in fifteen normal patients showed that approximately 18 per cent of the body weight is distributed over each ischial tuberosity; 21 per cent, over each thigh; and 5 per cent, over the sacrum. Three patients who had problems with sitting balance showed foci of unequal pressure which are at risk for decubitus ulceration.
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ranking = 0.2
keywords = sacrum
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6/8. Posterolateral spinal fusion for the treatment of scoliosis in myelodysplasia.

    Twenty-seven patients have undergone posterolateral spinal fusion for the treatment of scoliosis associated with myelodysplasia. Seventeen patients were girls, and 10 were boys. The average age at the time of surgery was 10.6 years in the girls and 11 years in the boys. The average preoperative curve was 78.52 degrees. All patients were fused at the sacrum; the upper level of fusion was at the fourth thoracic vertebra in 20 patients and at the third thoracic vertebra in 7 patients. Harrington instrumentation was used in 5 patients. The average improvement in curvature was 44.5%. Based on clinical and functional criteria, 16 patients had good results, 4 patients had fair results, and 7 patients had poor results.
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ranking = 0.2
keywords = sacrum
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7/8. Spondylocostal dysostosis with perinatal death and meningomyelocele.

    A preterm black girl was born at 35 weeks of gestation to a healthy nonconsanguineous couple. She had a very short trunk with disproportionately long extremities, mild prognathism, low-set ears, thoracolumbar meningomyelocele, and imperforate anus. She died 45 min after birth. Roentgenograms revealed hemivertebrae, block vertebrae, severe thoracic lordosis, absent sacrum, posterior fusion of some ribs with greater distance among them in the anterior thorax, and relatively long extremities. Internal examination showed an intact meningomyelocele extending from the first thoracic vertebra to the lumbosacral region, containing 150 mL of clear fluid. The lungs were severely hypoplastic. Spondylocostal dysostosis encompasses a spectrum of vertebral abnormalities ranging from spina bifida occulta to large meningomyelocele and from mild to severe thoracic deformities that produce pulmonary hypoplasia and respiratory insufficiency. Our case is one of the most severe ever described.
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ranking = 0.2
keywords = sacrum
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8/8. Instrumentation for correction and fixation of scoliosis in fibrous dysplasia of the thoracolumbar spine.

    A case report is presented in which correction of a thoracolumbar scoliosis, due to extensive fibrous dysplasia, is achieved using segmental spinal instrumentation with a 6-year follow-up. Pseudoarthrosis developed due to insufficient hook fixation at the sacrum.
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ranking = 0.2
keywords = sacrum
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