scholarly journals Complications of Posterior Fusion for Atlantoaxial Instability in Children With Down Syndrome

Neurospine ◽  
2021 ◽  
Vol 18 (4) ◽  
pp. 778-785
Author(s):  
Yoshiki Takeoka ◽  
Kenichiro Kakutani ◽  
Hiroshi Miyamoto ◽  
Teppei Suzuki ◽  
Takashi Yurube ◽  
...  
Keyword(s):  
Down Syndrome ◽  
Pediatric Patients ◽  
Perioperative Complications ◽  
Donor Site ◽  
Operation Time ◽  
Posterior Fusion ◽  
Atlantoaxial Instability ◽  
Children With Down Syndrome ◽  
Estimated Blood Loss ◽  
Upper Cervical

Objective: To clarify the complications of posterior fusion for atlantoaxial instability (AAI) in children with Down syndrome and to discuss the significance of surgical intervention.Methods: Twenty pediatric patients with Down syndrome underwent posterior fusion for AAI between February 2000 and September 2018 (age, 6.1 ± 1.9 years). C1–2 or C1–3 fusion and occipitocervical fusion were performed in 14 and 6 patients, respectively. The past medical history, operation time, estimated blood loss (EBL), duration of Halo vest immobilization, postoperative follow-up period, and intra- and perioperative complications were examined.Results: The operation time was 257.9 ± 55.6 minutes, and the EBL was 101.6 ± 77.9 mL. Complications related to the operation occurred in 6 patients (30.0%). They included 1 major complication (5.0%): hydrocephalus at 3 months postoperatively, possibly related to an intraoperative dural tear. Other surgery-related complications included 3 cases of superficial infections, 1 case of bone graft donor site deep infection, 1 case of C2 pedicle fracture, 1 case of Halo ring dislocation, 1 case of pseudoarthrosis that required revision surgery, and 1 case of temporary neurological deficit after Halo removal at 2 months postoperatively. Complications unrelated to the operation included 2 cases of respiratory infections and 1 case of implant loosening due to a fall at 9 months postoperatively.Conclusion: The complication rate of upper cervical fusion in patients with Down syndrome remained high; however, major complications decreased substantially. Improved intra- and perioperative management facilitates successful surgical intervention for upper cervical instability in pediatric patients with Down syndrome.

Craniovertebral Junction Abnormalities in Down Syndrome

Neurosurgery ◽  
2010 ◽  
Vol 66 (suppl_3) ◽  
pp. A32-A38 ◽  
Author(s):  
Todd C. Hankinson ◽  
Richard C.E. Anderson
Keyword(s):  
Down Syndrome ◽  
Cervical Spine ◽  
Craniovertebral Junction ◽  
Atlantoaxial Instability ◽  
Special Olympics ◽  
Cervical Instability ◽  
Neurologic Injury ◽  
Current Opinion ◽  
Children With Down Syndrome ◽  
Upper Cervical

Abstract CHILDREN WITH DOWN syndrome may have occipitocervical and atlantoaxial instability. To prevent neurologic injury during athletic competitions, such as the Special Olympics, radiographic cervical spine screening was established in 1983 as a prerequisite for participation in some events. This review discusses the biomechanics underlying upper cervical instability in children with Down syndrome, the evolution of cervical spine screening protocols, and current opinion regarding management for children with Down syndrome and upper cervical instability.

Morbidity Associated with Diverting Loop Ileostomies: Weighing Diversion in Rectosigmoid Resection

2017 ◽  
Vol 83 (7) ◽  
pp. 786-792
Author(s):  
Nathan Belkin ◽  
Liliana G. Bordeianou ◽  
Paul C. Shellito ◽  
Alexander T. Hawkins
Keyword(s):  
Adjuvant Chemotherapy ◽  
Postoperative Complications ◽  
Anterior Resection ◽  
Massachusetts General Hospital ◽  
Perioperative Complications ◽  
Primary Anastomosis ◽  
Operation Time ◽  
Emergency Department Visits ◽  
Rectosigmoid Resection ◽  
Estimated Blood Loss

Anterior resection with primary anastomosis is the procedure of choice for patients with rectosigmoid cancers with good sphincter function. Surgeons may perform an associated diverting loop ileostomy (DLI) to minimize the likelihood and/or the severity of an anastomotic leak. To examine the morbidity of DLIs, we performed a review of a prospectively maintained database. Participants included all patients at the Massachusetts General Hospital who underwent anterior resection from January 2013 to July 2015 for rectosigmoid cancers and who subsequently underwent adjuvant chemotherapy. The primary outcome was time to start of adjuvant chemotherapy. Secondary outcomes included length of hospitalization, perioperative complications, and 60-day postoperative complications. Inclusion criteria were met in 57 patients and DLI was performed in 21 (37%). The DLI group had higher estimated blood loss (431.7 vs 192.1 mL, P = 0.03) and a longer operation time (3.7 vs 2.3 hours, P = 0.0007). The DLI group took over a week longer to start adjuvant chemotherapy than the non-DLI group (median time to chemo: 43 vs 34 days, P = 0.002). Postoperatively, DLI was associated with a longer hospitalization (6.7 vs 3.1 days, P = 0.0003), more perioperative complications (57.1% vs 13.9%, P = 0.0006), and more 60-day read-missions or emergency department visits (38.1% vs 5.6%, P = 0.002). Ostomies are associated with appreciable morbidity. In turn, they do not eliminate postoperative complications. Surgeons should closely consider ostomy morbidity in rectosigmoid resection and institute a proactive approach toward identification and prevention of complications.

scholarly journals Factors Affecting Length of Stay Following 3-Column Spinal Osteotomies in Pediatric Patients

2019 ◽  
pp. 219256821989522
Author(s):  
So Kato ◽  
Taylor Dear ◽  
Stephen J. Lewis
Keyword(s):  
Body Weight ◽  
Postoperative Complications ◽  
Length Of Stay ◽  
Pediatric Patients ◽  
Perioperative Complications ◽  
Intraoperative Complications ◽  
Operation Time ◽  
Fluid Administration ◽  
Prolonged Stay ◽  
Factors Affecting

Study Design: A retrospective analysis. Objectives: Length of stay (LOS) is one of the important indicators for the quality of patient care. Although perioperative complications are known to be associated with longer LOS in general, little has been understood regarding LOS after 3-column spinal osteotomy for the rigid spinal deformity in pediatric population. The main objective of the article is to identify factors affecting the LOS in pediatric patients undergoing 3-column posterior spinal osteotomies. Methods: Following research ethics approval, a retrospective review was performed of 35 consecutive posterior 3-column spinal osteotomies performed on pediatric patients in a single academic institution. Patients’ demographic data, preoperative comorbidities, details of operative procedures, intraoperative complications, and postoperative complications were investigated, and LOS was compared among the groups. Results: The mean LOS was 9.0 days, and the median LOS was 7 days (range = 4-23 days). Low body weight and syndromic deformity were associated with longer LOS. Operation time ≥6 hours and total perioperative fluid administration greater than or equal to twice the estimated blood volume were associated with longer LOS. Among postoperative complications, those with respiratory complication had prolonged stay. Conclusions: Preoperative low body weight and syndromic scoliosis had longer LOS after 3-column osteotomies. Excessive fluid administration and respiratory complications were associated with longer LOS.

scholarly journals Myoarchitectonic advancement of the C2 spinous process for C1-C2 posterior fusion: A novel technique

2015 ◽  
Vol 6 (02) ◽  
pp. 267-271 ◽  
Author(s):  
Ajit Kumar Sinha ◽  
Sumit Goyal
Keyword(s):  
Bone Graft ◽  
Perioperative Complications ◽  
Spinous Process ◽  
Donor Site ◽  
Donor Site Morbidity ◽  
Posterior Fusion ◽  
Vascularized Bone Graft ◽  
Novel Technique ◽  
Posterior Arthrodesis ◽  
Vascularized Bone

ABSTRACT Study Design: Retrospective descriptive study of an innovative surgical technique. Objective: To assess the feasibility of using a large C2 spinous process as a vascularized bone graft donor with muscles attached to it in C1-C2 posterior fusion with evaluation of post operative fusion and pain in these cases. Summary of Background Data: C1-C2 posterior fusion essentially requires a bone graft and for this a separate incision is needed at the donor site with its associated morbidity. The procedure also entails detachment of muscles attached to the C2 spinous process. Due to the detachment of these muscles with important functions, postoperative nuchal pain is common in these patients. We developed a novel technique of harvesting the vascularized C2 spinous process as a bone graft to minimize the above-mentioned complications. Materials and Methods: Five patients with atlanto-axial dislocation due to various pathologies underwent C1-C2 posterior arthrodesis with the present technique. They were followed up for 6 to 18 months and were evaluated for feasibility of procedure, post operative fusion and post operative complications, especially pain. Results: The procedure was accomplished successfully in all patients without any perioperative complications. All patients were pain free 3 months after surgery—mean Visual Analogue Scale (VAS) was 0.4. Fusion (confirmed by plain radiography in three and by CT scan in two patients) was achieved in all five patients (100%). Conclusion: Myoarchitectonic advancement of C2 spinous process is a novel technique of C1-C2 posterior fusion in which a local vascularized bone graft is used avoiding donor site morbidity and at the same time preservation of dynamic function of muscles attached reduces the post operative pain.

scholarly journals Disfagia fase oral dan faring pada anak sindrom Down

2018 ◽  
Vol 48 (1) ◽  
pp. 102
Author(s):  
Susyana Tamin ◽  
Elvie Zulka ◽  
Iman Pradana Maryadi ◽  
Rahmanofa Yunizaf
Keyword(s):  
Down Syndrome ◽  
Pediatric Patients ◽  
Partial Trisomy ◽  
Neck Surgery ◽  
Chromosome 21 ◽  
Google Scholar ◽  
Endoscopic Evaluation ◽  
Children With Down Syndrome ◽  
Feeding Difficulty ◽  
Surgery Department

Latar Belakang: Sindrom Down merupakan kelainan kromosom autosomal yang terjadi akibat trisomi seluruh atau sebagian dari kromosom 21, yang terjadi kurang lebih 1 dari 700 kelahiran hidup. Berbagai studi mendapatkan bahwa gangguan makan (feeding difficulty) dan disfagia merupakan masalah yang umum terjadi dan terkadang persisten pada anak sindrom Down. Tujuan: Memaparkan karakteristik kelainan disfagia fase oral dan fase faring yang dapat timbul pada anak dengan sindrom Down menggunakan instrument pemeriksaan Fiberoptic Endoscopic Evaluation of Swallowing (FEES). Laporan kasus: Dilaporkan 8 pasien anak dengan sindrom Down yang didapatkan dari rekam medis pasien sejak Oktober 2016 hingga September 2017, yang dilakukan pemeriksaan FEES di Poli Endoskopi Bronkoesofagologi Departemen Telinga Hidung Tenggorok-Bedah Kepala Leher (THT-KL) Rumah Sakit Dr. Cipto Mangunkusumo. Metode: Pencarian literatur secara terstruktur dilakukan dengan menggunakan Pubmed, ClinicalKey, Cochrane, dan Google scholar, sesuai dengan pertanyaan klinis berupa bagaimana karakteristik disfagia pada pasien anak dengan sindrom Down melalui pemeriksaan FEES. Pemilihan artikel dilakukan berdasarkan kriteria inklusi dan eksklusi. Hasil didapatkan 1 artikel yang relevan. Hasil: Artikel yang didapat merupakan suatu studi retrospektif yang melaporkan gambaran deskriptif karakteristik disfagia pada anak dengan sindrom Down. Kesimpulan: Kelainan anatomis pada sindrom Down berperan pada terjadinya gangguan makan dan disfagia. ABSTRACTBackground: Down syndrome is an autosomal chromosomal disorder caused by entire or partial trisomy of chromosome 21, which occurs in approximately 1 out of 700 live births. Several studies had found that feeding difficulty and swallowing disorder (dysphagia) are common and persistent problems in children with Down syndrome. Purpose: to describe characteristics of abnormalities that can occur in children with Down syndrome using the Fiberoptic Endoscopic Evaluation of Swallowing (FEES) examination. Case report: 8 Pediatric patients with Down syndrome, obtained from medical record of FEES examination in Endoscopic Bronchoesophagology Clinic of Otorhinolaryngology-Head and Neck Surgery Department (ENT-HNS) Cipto Mangunkusumo Hospital, from October 2016 up to September 2017. Method: A structured literature search was performed using Pubmed, ClinicalKey, Cochrane, and Google scholar, according to clinical question of how the characteristics of dysphagia in pediatric patients with Down syndrome through FEES examination? The selection of articles is based on inclusion and exclusion criteria which resulted in 1 relevant paper. Results: The article obtained was a retrospective study reporting descriptive characteristics of dysphagia in children with Down syndrome. Conclusion: Anatomical abnormalities in children with Down syndrome play a role in eating disorders and dysphagia. Keywords:

scholarly journals Roentgenological study of the upper cervical spine in children with Down syndrome.

1990 ◽  
Vol 39 (1) ◽  
pp. 288-291
Author(s):  
Masaru Higo ◽  
Shyougo Harada ◽  
Tokutarou Nagayama ◽  
Kouji Inaba ◽  
Nobuhiko Sunahara ◽  
...  
Keyword(s):  
Down Syndrome ◽  
Cervical Spine ◽  
Upper Cervical Spine ◽  
Children With Down Syndrome ◽  
Upper Cervical

scholarly journals Laparoendoscopic single-site nephrectomy versus conventional laparoendoscopic nephrectomy for kidney tumor: a systematic review and meta-analysis

2019 ◽  
Vol 39 (8) ◽  
Author(s):  
Dengyuan Feng ◽  
Rong Cong ◽  
Hong Cheng ◽  
Yi Wang ◽  
Jiajun Zhou ◽  
...  
Keyword(s):  
Perioperative Complications ◽  
Meta Analysis ◽  
Intraoperative Complications ◽  
Operation Time ◽  
Single Site ◽  
Cochrane Library ◽  
Kidney Tumor ◽  
Analgesic Requirement ◽  
Laparoendoscopic Single Site ◽  
Estimated Blood Loss

Abstract With the increasing application of laparoendoscopic single-site nephrectomy (LESS-N) in kidney tumor, accumulating studies compared it with conventional laparoendoscopic nephrectomy (CL-N). However, controversial outcomes were reported. Hence, this meta-analysis was carried out to clarify these issues. Online databases PubMed, EMBASE and the Cochrane Library were searched comprehensively for eligible studies published before 24 July 2018. Odds ratios (ORs) or standardized mean differences (SMDs) with corresponding 95% confidence intervals (CIs) were collected for evaluating the pooled results of relevant outcomes. Ultimately, 13 eligible articles were enrolled. Meanwhile, compared with CL-N, LESS-N was related to a longer operation time (SMD: 0.40; 95% CI, 0.23–0.58; P=0.000), a shorter length of hospital stay (LOS) (SMD: −0.32; 95% CI, −0.62 to −0.02; P=0.034), a lower visual analog scale (VAS) score (SMD: −0.89; 95% CI, −1.22 to −0.56; P=0.000) and a lower analgesic requirement (SMD: −0.55; 95% CI, −0.87 to −0.23; P=0.001). There was no statistical difference in the postoperative day of oral intake, estimated blood loss (EBL), conversion rate, perioperative complications, intraoperative complications, postoperative complications, minor complications and major complications between LESS-N and CL-N. Patients with LESS-N for kidney tumor could have a longer operation time and shorter LOS, and meanwhile could need less analgesics and suffer less pain after LESS-N.

Evaluation of Pediatrician Adherence to the American Academy of Pediatrics Health Supervision Guidelines for Down Syndrome

2018 ◽  
Vol 123 (5) ◽  
pp. 387-398 ◽  
Author(s):  
Meghan E. O'Neill ◽  
Alexandra Ryan ◽  
Soyang Kwon ◽  
Helen J. Binns
Keyword(s):  
Primary Care ◽  
Down Syndrome ◽  
American Academy ◽  
Medical Records ◽  
Atlantoaxial Instability ◽  
Anticipatory Guidance ◽  
Comorbid Conditions ◽  
Children With Down Syndrome ◽  
Health Supervision ◽  
American Academy Of Pediatrics

Abstract The American Academy of Pediatrics's guideline on health supervision for children with Down syndrome (DS) offers pediatricians guidance to improve detection of comorbid conditions. Pediatrician adherence has not yet been comprehensively evaluated. Medical records of 31 children with DS who received primary care at two urban academic clinic sites from 2008–2012 were reviewed. Data was extracted on adherence to age-specific individual guideline components for each subject by year-of-life (total 84 years-of-life). Overall adherence across all components was 83% (2001 guideline) and 67% (2011 guideline). Adherence to thyroid, hearing, vision, and developmental components was >85%, and anticipatory guidance regarding atlantoaxial instability and sexuality was <35%. Overall adherence was higher when a subject was younger and when a provider was an attending-level pediatrician.

Symptomatic Atlantoaxial Instability Associated With Medical and Rehabilitative Procedures in Children With Down Syndrome

PEDIATRICS ◽  
1990 ◽  
Vol 85 (3) ◽  
pp. 447-449
Author(s):  
Michael E. Msall ◽  
Mary E. Reese ◽  
Kathleen DiGaudio ◽  
Kim Griswold ◽  
Carl V. Granger ◽  
...  
Keyword(s):  
Down Syndrome ◽  
Case Series ◽  
Medical Genetics ◽  
Atlantoaxial Instability ◽  
Children With Down Syndrome ◽  
Radiographic Screening

The Canadian College of Medical Genetics recently questioned the rationale for radiographic screening for atlantoaxial instability in Down syndrome. We report a case series of four children with Down syndrome with symptomatic atlantoaxial instability and followed for more than 5 years. In all cases a medical or rehabilitational procedure was associated with significant apnea, cardiopulmonary compromise, or severe neurological impairments. None of these patients were screened radiographically. The need for protocols to detect atlantoaxial instability in children with Down syndrome undergoing medical and rehabilitational procedures is highlighted by these cases.

Sign in / Sign up

Export Citation Format

Share Document