Cases reported "Scoliosis"

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1/13. Deep wound infections after neuromuscular scoliosis surgery: a multicenter study of risk factors and treatment outcomes.

    STUDY DESIGN: A retrospective case-control study evaluating risk factors for infection, causative organisms, and results of treatment in patients with cerebral palsy or myelomeningocele who underwent fusion for scoliosis was performed. OBJECTIVES: To identify risk factors for infection, and to characterize the infections in terms of infecting organisms and response to treatment. SUMMARY OF BACKGROUND DATA: No previous studies have analyzed risk factors or causative organisms, nor have they indicated results of treatment for infections in this group of patients. methods: After a 10-year retrospective review of 210 surgically treated patients, deep wound infections developed in 16 patients with myelomeningocele and 9 patients with cerebral palsy. These patients were studied extensively for possible risk factors, along with 50 uninfected patients matched for age, diagnosis, and year of surgery. Statistical testing was performed to identify risk factors. The courses of the infections were characterized in terms of organisms isolated and response to treatment. Treatment was performed in a stepwise fashion and classified in terms of the most successful step: debridement and closure, granulation over rods, or instrumentation removal. RESULTS: Of the 10 risk factors tested, 2 were found to be significant: degree of cognitive impairment and use of allograft. Findings showed that 52% of the infections were polymicrobial. Gram-negative organisms were isolated as commonly as gram-positive organisms. The most common organisms were coagulase-negative Staphylococcus, enterobacter, enterococcus, and escherichia coli.- debridement and closure were successful in 11 of 25 patients with deep wound infection. Of the 14 patients with infection not resolved by serial debridements and closure, 2 were managed successfully by allowing the wound to granulate over rods, and 7 required rod removal for persistent wound drainage. There were three symptomatic pseudarthroses. Infections resulting from gram-positive organisms were most often managed successfully with debridement and closure (P = 0.012). CONCLUSIONS: patients with cerebral palsy or myelomeningocele who have severe cognitive impairment, and those who received allograft may be at increased risk for infection. Infections are more often polymicrobial and caused by gram-negative organisms than is typical for elective orthopedic procedures. This suggests an enteric source. Treatment with debridement and closure was not always successful. patients in whom infection develops are then at increased risk for pseudarthrosis.
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keywords = wound infection, wound
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2/13. 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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ranking = 0.16640253223868
keywords = wound infection, wound
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3/13. Late operative site pain with isola posterior instrumentation requiring implant removal: infection or metal reaction?

    OBJECTIVES: To elucidate the cause of late operative site pain in six cases of scoliosis managed with Isola posterior instrumentation that required removal of the implants. METHOD: Microbiologic examination of wound swabs and enriched culture of operative tissue specimens was undertaken in all cases. Histologic study of the peri-implant membranes also was conducted. RESULTS: The presentation in all cases was similar: back pain appearing between 12-20 months after surgery, followed by a local wound swelling leading to a wound sinus. In only one of these cases was the discharge positive for bacterial growth. Implant removal was curative. Histologic examination of tissue specimens revealed a neutrophil-rich granulation tissue reaction suggestive of an infective etiology despite the failure to isolate organisms. Within the granulation tissue was metallic debris that varied from very sparse to abundant from fretting at the distal cross-connector junctions. A review of recent literature describing similar problems suggests that late onset spinal pain is a real entity and a major cause of implant removal. CONCLUSIONS: On reviewing the evidence for an infective etiology versus a metallurgic reaction etiology for these cases of late onset spinal pain, it was concluded that a subacute low-grade implant infection was the main cause. Histologic findings would seem to confirm low-grade infection. There may be more than one causative factor for late operative site pain, as it is possible that fretting at cross connection junctions may provide the environment for the incubation of dormant or inactive microbes.
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ranking = 0.0023772098518442
keywords = wound
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4/13. Full-thickness thoracic laminar erosion after posterior spinal fusion associated with late-presenting infection.

    STUDY DESIGN: A case report describes unilateral complete laminar erosion of the caudal thoracic spine and late-presenting infection in a patient 10 years after anteroposterior reconstruction for scoliosis. OBJECTIVE: To present an unusual but significant complication that may occur after implantation of spinal instrumentation. SUMMARY OF BACKGROUND DATA: The reported patient presented with a deep infection and persistent back pain 10 years after successful anteroposterior reconstruction for adult idiopathic scoliosis. Delayed onset infections after implantation of spinal instrumentation are infrequent, yet when present, often require hardware removal. methods: The case of a 51-year-old woman who underwent irrigation and debridement for a late-presenting infection and removal of posterior hardware 10 years after her index procedure is presented. Interoperatively, it was noted that full-thickness laminar erosion was present from T4 to T12. RESULTS: The patient was taken to the operating room for wound irrigation, debridement, and hardware removal. It was discovered that a Cotrel-Dubousset rod placed on the convexity of the curve had completely eroded through the lamina of T7-T12. Infectious material was found along the entire length of both the convex and concave Cotrel-Dubousset rods. Intraoperative cultures grew staphylococcus epidermidis and propionibacterium acnes. Intravenous and oral antibiotics were administered, resulting in resolution of the infection and preoperative pain. CONCLUSIONS: The exact role of late-presenting infection with regard to the laminar erosion and rod migration seen in this case remains to be elucidated. However, the authors believe the primary cause of bony erosion was mechanical in origin. Regardless, most spine surgeons will treat many patients who have had posterior spinal implants and will perform hardware removal on a significant number of these patients during their careers. A full-thickness laminar erosion exposes the spinal cord to traumatic injury during hardware removal and debridement. This case is presented as a cautionary note to help surgeons become cognizant of a potentially devastating complication.
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ranking = 0.00079240328394807
keywords = wound
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5/13. Fusionless surgery for scoliosis: 2-17 year radiographic and clinical follow-up.

    STUDY DESIGN: Descriptive case series. OBJECTIVE: To determine whether fusionless, multiple vertebral wedge osteotomy can safely obtain correction of the deformity with adolescent idiopathic scoliosis (AIS). SUMMARY OF BACKGROUND DATA: To our knowledge, no such attempts to manage the AIS with fusionless, vertebral osteotomies have been reported. methods: A total of 20 consecutive patients were treated since 1987. Deformity correction, complications, respiratory function, and patient-oriented outcome were investigated. RESULTS: There were 20 patients (17 females and 3 males), including 19 with idiopathic and 1 with syringomyelia scoliosis, who underwent surgery at an average age of 16.4 years and were followed for 8.9 years (range 2-17) on average. There were no neurologic complications. One superficial wound infection necessitated debridement. There were 2 patients converted to posterior instrumentation surgery because of deterioration of the deformity. The average Cobb angle of 64.0 degrees before surgery was corrected to 48.2 degrees at 8.9 years after surgery. Decline of the pulmonary function test after surgery was not statistically significant. The patients' responses to questions about function and pain were favorable. CONCLUSION: Deformity with AIS was safely corrected with fusionless, multiple vertebral wedge osteotomy.
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ranking = 0.16640253223868
keywords = wound infection, wound
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6/13. adolescent scar contracture scoliosis caused by back scalding during the infantile period.

    To investigate the pathogenesis, clinical manifestation and treatment of the adolescent scar contracture scoliosis caused by back scalding during infancy. From August 1997 to May 2005, about 1300 patients with scoliosis received surgery in our department. Only four of them were diagnosed with adolescent scar contracture scoliosis. One patient was first treated with skin expansion, back scar excision, and skin flap transfer, followed with anterior correction with TSRH instrumentation. Two patients were first treated with back scar excision and anterior spinal release, then treated with posterior correction with TSRH instrumentation; thoracoplasty was performed after 50 days in halo-wheelchair traction. The other patient was treated with posterior correction with TSRH instrumentation. No management of scalding was performed on the fourth patient. Anterior release and posterior correction were performed at intervals of 3 weeks. The deformities of four patients were well corrected. The trunk balance was restored and the pelvis leveled. The skin incision wounds healed well. Minor loss of correction was recorded during the last follow-up.
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ranking = 0.00079240328394807
keywords = wound
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7/13. Simultaneous correction of pelvic obliquity, frontal plane, and sagittal plane deformities in neuromuscular scoliosis using a unit rod with segmental sublaminar wires: a preliminary report.

    Ten patients with neuromuscular scoliosis and pelvic obliquity had segmental spinal instrumentation using a unit Luque rod with sublaminar wires and fixation into the pelvis. Nine of the 10 patients also had anterior spinal fusion without instrumentation before the posterior procedure. Average preoperative pelvic obliquity was 42 degrees which was corrected to 6 degrees (82% correction). Average preoperative scoliosis was 92 degrees, which was corrected to 16 degrees (81% correction). Complications included a wound hematoma in one patient and a superficial wound dehiscence in another. There have been no pseudarthroses or hardware failures to date. Excellent correction of the pelvic obliquity and the spinal curve in neuromuscular scoliosis can be obtained with use of a unit rod and without use of anterior instrumentation.
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ranking = 0.0015848065678961
keywords = wound
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8/13. Surgical treatment of adult scoliosis. A review of two hundred and twenty-two cases.

    We evaluated the cases of 222 patients older than twenty years in whom scoliosis was the primary diagnosis. No patient had had prior surgical treatment. The diagnoses were idiopathic scoliosis in 160 patients, paralytic scoliosis in forty-four, and congenital scoliosis in eleven, and there were miscellaneous diagnoses in seven patients. The average age of the patients when first seen was 30.7 years. The indications for operation were pain, progression of the curve, magnitude of the curve, and cardiopulmonary symptoms. Preoperative traction, including halo-femoral traction, did not result in increased correction when compared with the initial supine side-bending roentgenogram. A one-stage fusion was performed in 174 patients and multiple-stage procedures, in forty-eight patients. At an average follow-up of 3.6 years the average loss of correction was 6.2 degrees, 68 per cent of the patients were free of pain, and a solid fusion had been obtained in all but six patients. Complications developed in 53 per cent of the patients, the most common problems being pseudarthrosis, urinary tract infection, wound infection, instrumentation problems, a pulmonary disorder, and loss of lumbar lordosis. paraplegia occurred in one patient. The over-all mortality rate was 1.4 per cent. Complications increased with age, and the highest mortality rate was in patients with congenital scoliosis who had cor pulmonale.
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ranking = 0.16640253223868
keywords = wound infection, wound
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9/13. scoliosis and maple syrup urine disease.

    The intermediate variant of maple syrup urine disease produced frequent infections and significant mental retardation in a young female patient recently treated for scoliosis. There were no problems with infection, wound healing, or fusion with a regimen consisting of a low protein diet, perioperative antibiotics, good hydration, and early postoperative ambulation.
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ranking = 0.00079240328394807
keywords = wound
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10/13. Excision of hemivertebrae and wedge resection in the treatment of congenital scoliosis.

    The results of anterior and posterior excision or wedge resection of a hemivertebra and arthrodesis of the spine were reviewed retrospectively for thirty-seven patients. The degree of correction that was obtained and maintained, the balance and alignment of the trunk, changes in pelvic obliquity, and associated complications were evaluated. The average age at the time of the operation was twelve years (range, six months to forty-two years). The average duration of follow-up was six years (range, two to nineteen years). The resection was at the mid-thoracic level in six patients, at the thoracolumbar level in nine, at the mid-lumbar level in seven, and at the lumbosacral level in seventeen. (Two patients had an excision of a hemivertebra at two levels.) Instrumentation was used in twenty-eight patients. Postoperatively, all patients were managed with a body cast, with a unilateral or bilateral pantaloon extension, for four to six months. The instrumentation allowed early walking and the use of a unilateral rather than a bilateral pantaloon extension. The index curve (the curve containing the hemivertebra) averaged 54 degrees (range, 18 to 132 degrees) preoperatively, 33 degrees (range, 0 to 105 degrees) postoperatively, and 35 degrees (range, 0 to 110 degrees) at the most recent follow-up evaluation. A measurable improvement in balance was achieved and maintained in nineteen patients. Pelvic obliquity did not change appreciably, as it was related primarily to limb-length inequality in this series. Complications included a temporary nerve-root lesion in seven patients, a permanent neurological deficit involving the first sacral nerve root in one patient, a pseudarthrosis in three patients, and a wound infection in three patients. Six patients had extension of the arthrodesis to include additional vertebrae.
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ranking = 0.16640253223868
keywords = wound infection, wound
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