scholarly journals Progressive Scoliosis and Syringomyelia - Questions of Surgical Approach

Folia Medica ◽  
2018 ◽  
Vol 60 (2) ◽  
pp. 261-269 ◽  
Author(s):  
Mikhail Mikhaylovskiy ◽  
Vyacheslav Stupak ◽  
Vadim Belozerov ◽  
Nikolay Fomichev ◽  
Anatoliy Lutsik ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Surgical Correction ◽  
Neurological Deficits ◽  
Spinal Deformities ◽  
Loss Of Correction ◽  
Scoliotic Deformity ◽  
Scoliosis Correction ◽  
The Moment ◽  
Comparison Of The Results

Abstract Background: The rate of scoliosis in syringomyelia patients ranges from 25 to 74.4%. In turn, syringomyelia occurs in 1.2% to 9.7% of scoliosis patients. Aim: To evaluate outcomes of surgical correction of the scoliotic deformity in syringomyelia patients. Materials and methods: Between 1996 and 2015, 3120 patients with scoliosis of various etiologies were treated at the Clinic for Child and Adolescent Vertebrology of the Novosibirsk Research Institute of Traumatology and Orthopedics. We conducted a retrospective analysis of syringomyelia-associated scoliosis cases that required surgical correction. Results: Syringomyelia was found in 33 patients (1.05%) out of 3120 patients with spinal deformities of various etiologies; in 21 patients (0.9%) with idiopathic scoliosis of 2334 patients. In identifying the neurological deficit, the recommended first step is to perform neurosurgery. Nineteen patients were operated using the CDI, 4 patients underwent correction VEPTR, in 1 case instrumentation could not be established, 9 patients are undergoing treatment in the department of neurosurgery at the moment. Worsening of neurological deficits was not observed in any patient. Conclusion: A comparison of the results of syringomyelia-associated scoliosis correction with the data of other authors was done. The choice of surgery tactics is strictly individual and depends on the size of the cavity. The result of surgical intervention is generally positive and the loss of correction by the end of follow-up is negligible.

scholarly journals Procedure of complex braided wrapping of ascending aorta in her poststenotic dilation while doing correction of aortal stenosis

2020 ◽  
Vol 87 (9-10) ◽  
pp. 18-21
Author(s):  
V. V. Popov ◽  
A. A. Bolshak
Keyword(s):  
Ascending Aorta ◽  
Main Group ◽  
Surgical Correction ◽  
Control Group ◽  
Valve Prosthesis ◽  
Original Procedure ◽  
Aortal Valve ◽  
The Moment ◽  
Aorta Diameter

Objective. To study clinical possibilities of original procedure of the ascending aorta braid-like bandage for her poststenotic dilation while performance of the aortal stenosis surgical correction. Materials and methods. To the main Group 196 patients were included those, who were operated on for prevailing aortal stenosis, conjoined with poststenotic dilation of ascending aorta. In accordance to the echocardiographic investigation data the ascending aorta diameter preoperatively have constituted (47.7 ± 1.7) mm. In all the patients the aortal valve prosthesis was performed together with complex braided wrapping of ascending aorta. Into the control group 121 patients were included, in whom Bentall intervention was accomplished with vascular prosthesis of ascending aorta. Results. Hospital lethality in the main group have constituted 0.5%. Diameter of ascending aorta in the moment of hospital discharge have constituted (39.1 ± 1.5) mm, and in late follow-up period - (40.3 ± 1.1) mm. Conclusion. Basing on clinical experience gained, it is expedient to recommend the original procedure of braided wrapping of ascending aorta in presence of her poststenotic dilation while performing surgical correction of prevailing aortal stenosis.

scholarly journals The lateral infratrigeminal transpontine window to deep pontine lesions

2015 ◽  
Vol 123 (3) ◽  
pp. 699-710 ◽  
Author(s):  
Paolo Ferroli ◽  
Marco Schiariti ◽  
Roberto Cordella ◽  
Carlo Boffano ◽  
Simone Nava ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Surgical Intervention ◽  
Neurological Deficits ◽  
Critical Area ◽  
Surgical Indications ◽  
Surgical Strategies ◽  
Csf Leakage ◽  
New Knowledge ◽  
Pontine Lesion

OBJECT Surgery of brainstem lesions is increasingly performed despite the fact that surgical indications and techniques continue to be debated. The deep pons, in particular, continues to be a critical area in which the specific risks related to different surgical strategies continue to be examined. With the intention of bringing new knowledge into this important arena, the authors systematically examined the results of brainstem surgeries that have been performed through the lateral infratrigeminal transpontine window. METHODS Between 1990 and 2013, 29 consecutive patients underwent surgery through this window for either biopsy sampling or for removal of a deep pontine lesion. All of this work was performed at the Department of Neurosurgery of the Istituto Nazionale Neurologico "Carlo Besta", in Milan, Italy. A retrospective analysis of the findings was conducted with the intention of bringing further clarity to this important surgical strategy. RESULTS The lateral infratrigeminal transpontine window was exposed through 4 different approaches: 1) classic retrosigmoid (15 cases), 2) minimally invasive keyhole retrosigmoid (10 cases), 3) translabyrinthine (1 case), and 4) combined petrosal (3 cases). No deaths occurred during the entire clinical study. The surgical complications that were observed included hydrocephalus (2 cases) and CSF leakage (1 case). In 6 (20.7%) of 29 patients the authors encountered new neurological deficits during the immediate postoperative period. All 6 of these patients had undergone lesion removal. In only 2 of these 6 patients were permanent sequelae observed at 3 months follow-up. These findings show that 93% of the patients studied did not report any permanent worsening of their neurological condition after this surgical intervention. CONCLUSIONS This retrospective study supports the idea that the lateral infratrigeminal transpontine window is both a low-risk and safe corridor for either biopsy sampling or for removal of deep pontine lesions.

scholarly journals SURGICAL CORRECTION OF KYPHOSIS ASSOCIATED WITH SCHEUERMANN’S DISEASE

2005 ◽  
pp. 050-055
Author(s):  
Mikhail Vitalyevich Mikhailovsky ◽  
Vyacheslav Viktorovich Novikov ◽  
Aleksandr Sergeyevich Vasyura ◽  
Maya Nikolayevna Lebedeva
Keyword(s):  
Interbody Fusion ◽  
Surgical Intervention ◽  
Two Stage ◽  
Scheuermann’S Disease ◽  
Scheuermann's Disease ◽  
Loss Of Correction ◽  
Kyphosis Correction ◽  
Thoracic And Lumbar Spine ◽  
Surgery Department

Objective. To analyze the results of two-stage surgical treatment of progressive kyphosis associated with Scheuermann’s disease performed in the Spine Surgery Department for Children and Adolescents from 1996 till 2004. Material and Methods. Fourteen patients were surgically treated. Surgical intervention included segmental vertebrectomy, interbody fusion, and kyphosis correction with Cotrel – Dubousset Instrumentation (CDI). Results. Kyphosis was reduced from 78.1° to 43.4°; the loss of correction during the follow-up period (minimum 2 years) was 4.4°. Sagittal contour of the lower thoracic and lumbar spine was also normalized. Conclusion. Two-stage surgical intervention permits to achieve significant cosmetic and pain-reducing effect in patients with major kyphosis associated with Scheuermann’s disease.

scholarly journals Evaluation of parallel endplate osteotomy for severe rigid spinal deformities: a retrospective analysis of 36 cases with a minimum 2-year follow-up

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Hang Liao ◽  
Peng Xie ◽  
Guizhou Zheng ◽  
Houguang Miao ◽  
Ningdao Li ◽  
...  
Keyword(s):  
Operative Time ◽  
Bodily Pain ◽  
Clinical Results ◽  
Spinal Deformities ◽  
Effective Technique ◽  
Estimated Blood Loss ◽  
Sf 36 ◽  
Scoliosis Correction ◽  
Median Operative Time

Abstract Background To report on the technique and results of parallel endplate osteotomy (PEO) for severe rigid spinal deformity. Methods We retrospectively reviewed the clinical data of 36 patients with severe rigid spinal deformities who underwent PEO between July 2016 and December 2018 and who were followed up for at least 24 months. Results Following PEO, the kyphosis and scoliosis correction rates reached 77.4 ± 14.0% and 72.2 ± 18.2%, respectively. The median intraoperative estimated blood loss was 1500 mL and the median operative time was 6.8 h. The SF-36 scores of physical function, role-physical, bodily pain, general health, vitality, social function, role-emotional and mental health changed from 62 ± 28, 51 ± 26, 49 ± 29, 35 ± 30, 53 ± 28, 45 ± 30, 32 ± 34 and 54 ± 18 at baseline to 81 ± 16, 66 ± 41, 72 ± 40, 64 ± 44, 75 ± 25, 71 ± 46, 66 ± 34 and 76 ± 28 at 12 months postoperatively, 82 ± 32, 67 ± 42, 81 ± 30, 71 ± 41, 80 ± 30, 74 ± 36, 68 ± 35 and 85 ± 33 at 18 months postoperatively, and 86 ± 21, 83 ± 33, 88 ± 26, 79 ± 39, 86 ± 36, 86 ± 48, 80 ± 47 and 91 ± 39 at 24 months postoperatively, respectively. Conclusions PEO is an effective technique for successful correction of spinal deformities. At the two-year follow-up visit, all patients achieved better clinical results based on the SF-36 scores.

scholarly journals Surgical correction of pediatric spinal deformities with coexisting intraspinal pathology: A case report and literature review

2021 ◽  
Vol 12 ◽  
pp. 381
Author(s):  
Daphne Li ◽  
Douglas E. Anderson ◽  
Russ P. Nockels
Keyword(s):  
Spinal Cord ◽  
Literature Review ◽  
Tumor Resection ◽  
Deformity Correction ◽  
Tethered Cord ◽  
Surgical Correction ◽  
Spinal Deformities ◽  
Medline Search ◽  
Scoliosis Correction

Background: Surgical correction of spinal deformities with coexisting intraspinal pathology (SDCIP) requires special consideration to minimize risks of further injury to an already abnormal spinal cord. However, there is a paucity of literature on this topic. Here, the authors present a pediatric patient with a residual pilocytic astrocytoma and syringomyelia who underwent surgical correction of progressive postlaminectomy kyphoscoliosis. Techniques employed are compared to those in the literature to compile a set of guidelines for surgical correction of SDCIP. Methods: A systematic MEDLINE search was conducted using the following keywords; “pediatric,” “spinal tumor resection,” “deformity correction,” “postlaminectomy,” “scoliosis correction,” “intraspinal pathology,” “tethered cord,” “syringomyelia,” or “diastematomyelia.” Recommendations for surgical technique for pediatric SDCIP correction were reviewed. Results: The presented case demonstrates recommendations that primarily compressive forces on the convexity of the coronal curve should be used when performing in situ correction of SDCIP. Undercorrection is favored to minimize risks of traction on the abnormal spinal cord. The literature yielded 13 articles describing various intraoperative techniques. Notably, seven articles described use of compressive forces on the convex side of the deformity as the primary mode of correction, while only five articles provided recommendations on how to safely and effectively surgically correct SDCIP. Conclusion: The authors demonstrated with their case analysis and literature review that there are no clear current guidelines regarding the safe and effective techniques for in situ correction and fusion for the management of pediatric SDCIP.

Surgical management of craniopharyngiomas

1986 ◽  
Vol 65 (1) ◽  
pp. 22-27 ◽  
Author(s):  
David S. Baskin ◽  
Charles B. Wilson
Keyword(s):  
Tumor Size ◽  
Surgical Intervention ◽  
Neurological Deficits ◽  
Direct Result ◽  
Content Type ◽  
Fair Result ◽  
Transcallosal Approach ◽  
Common Presentation ◽  
Fine Print

✓ A series of 74 patients with craniopharyngiomas were treated during a 15-year period. Of the 74 patients, 40 were males and 34 were females, with a mean age of 27 years (range 3 to 65 years). Twenty-eight patients (38%) were less than 18 years of age. Remission was defined as clinical improvement with stable ophthalmological and neurological status, radiological evidence of a decrease in tumor size, and either a continued decrease or a stable tumor size on follow-up radiological evaluations. A fair result was considered remission with new neurological deficits related to surgical intervention. All other results were considered a failure. The mean follow-up period in this study was 4 years, with 100% of the patients monitored. In children, the most common presentation was that of growth failure (93%). In adults, sexual dysfunction was the most common presentation, with 88% of males presenting with impotence or marked decrease in sexual drive, and 82% of females presenting with primary or secondary amenorrhea, often associated with galactorrhea. Considering the pediatric and adult populations together, the most common presenting symptom was visual dysfunction, with 71% of patients presenting in this manner. Fifty percent of patients presented with severe headache. The most frequent preoperative finding was a visual field defect, with 72% of patients so affected; 42% of patients had preoperative hypothyroidism and 24% had hypoadrenalism. Diabetes insipidus was present preoperatively in 23%. Hydrocephalus was uncommon, being present in only 15%. A subfrontal craniotomy was used in 47% of patients, a transsphenoidal approach in 39%, a subtemporal approach in 11%, a transcallosal approach in 5%, and a suboccipital craniectomy in 2%. Multiple procedures were required in 15% of patients in order to provide significant relief of compressive symptomatology. The results of therapy indicate that total tumor removal was deemed to have been achieved in only seven patients, six of whom have had no recurrence. However, 91% of patients are in remission, one had a fair result, and two died as a direct result of surgical intervention. One patient died from uncontrolled disease, and three patients died from unrelated causes. The results of this study indicate that radical subtotal removal followed by radiotherapy is an acceptable treatment for craniopharyngioma.

Preoperative and postoperative developmental attainment in patients with sagittal synostosis: 5-year follow-up

2011 ◽  
Vol 7 (2) ◽  
pp. 121-126 ◽  
Author(s):  
Maggie Bellew ◽  
Mark Liddington ◽  
Paul Chumas ◽  
John Russell
Keyword(s):  
Developmental Delay ◽  
Surgical Intervention ◽  
Surgical Correction ◽  
Control Group ◽  
Corrective Surgery ◽  
Developmental Assessment ◽  
Sagittal Synostosis ◽  
Locomotor Function ◽  
Locomotor Control

Object The object of this study was to clarify whether improved developmental attainment following surgical correction of sagittal synostosis (SS), previously identified at initial postoperative assessment, is maintained at longer-term follow-up at 5 years of age. Methods The study involved 32 children with SS who underwent corrective surgery at a mean (± SD) age of 8.5 ± 7.25 months (range 2.8–39.9 months). All the children were assessed preoperatively, at 7 months postoperatively, and at 5 years of age, using the Griffiths Mental Development Scales. A control group consisted of 23 children with SS who had received developmental assessment on 2 or more occasions without surgical intervention (8 of these children had had follow-up at 5 years of age). Results The data indicated that, prior to surgical correction, children with SS had poorer Gross Locomotor function than other areas of development and that, following surgical intervention, the deficit resolved (even where there was severe developmental delay). The results further showed that improvement in Gross Locomotor function observed at 7 months postoperatively was further improved upon by 5 years of age. The same was true for their overall General Quotient, even in those children exhibiting severe developmental delay. Lesser improvements across time were shown for other skill areas. The children with SS who did not undergo surgery did not show any improvement in development, and in fact a deterioration in fine locomotor control was identified in these patients. Conclusions The results of this study suggest that corrective surgery for SS has a positive early impact on development, which is maintained and improved upon by 5 years of age, and that this surgery therefore offers more than simply a cosmetic improvement. Furthermore, the results suggest that not operating on children with SS means not only that this opportunity for developmental gain is missed, but that it may also cause an actual deterioration in developmental attainment.

scholarly journals Horizontal Correction of Scoliotic Deformity with High-Density Pedicle Screw Constructs: A Retrospective Analysis of 40 Patients

2020 ◽  
pp. 1-8
Author(s):  
Charlotte Debaud ◽  
Charlotte Debaud ◽  
Adrien Felter ◽  
Georges Hayek ◽  
Christian Garreau de Loubresse
Keyword(s):  
Pedicle Screw ◽  
Mean Amplitude ◽  
High Density ◽  
Surgical Correction ◽  
Scoliosis Surgery ◽  
3D Analysis ◽  
Global Level ◽  
3D Reconstructions ◽  
Scoliotic Deformity ◽  
Scoliosis Correction

Purpose: To report radiologic outcomes in the horizontal plane after scoliosis correction with high-density pedicle screw constructs through a sterEOS®-3D analysis. Methods: We conducted a retrospective monocentric study on scoliotic patients who underwent a surgical correction with high-density constructs. SterEOS®-3D reconstructions were modelled from pre and postoperative EOS® acquisitions. Amplitude of surgical correction and residual deformity were analysed for rotational parameters (vertebrae vectors coordinates, apical vertebral rotation (AVR), intervertebral rotations, Torsion Index) and transversal offset parameters (Spread of Coronal Offsets (SCO), mean of coronal offsets (CO), T9 and L3 to Gravity Line (GL) CO, T9/L3 Transverse Gravitational Deviation Index (TGDI), T9/L3 TGDI θ categories). Results: 80 sterEOS®3D reconstructions were analysed. Paired t-test comparisons between pre and postoperative values showed a significant reduction for Cobb angles (p<0.0001) and AVR (p = 0.0024) but not for TI (p = 0.69). 51% of the curves with a preoperative AVR > 10° were corrected at a segmental level with an average de-rotation amplitude of 19.3° +/- 8° and 56% at a global level with an average de-torsion index of 54% +/- 30%. Correction of SCO was effective for 95% of patients with a mean amplitude of 30mm +/- 10mm and was associated with a significant reduction in T9 and L3 to GL CO (34mm ± 24mm and 7.6mm +/-10mm respectively). Conclusion: Horizontal corrections achieved with high-density constructs in scoliosis surgery are more significant on translation than rotation at a segmental and global level.

scholarly journals TREATMENT OF PATIENTS WITH GRADE III–IV THORACOLUMBAR SCOLIOSIS AFTER PRIOR SURGERY BY HARRINGTON METHOD

2006 ◽  
pp. 033-037
Author(s):  
Mukhammad Tablikhanovich Sampiev ◽  
Aleksandr Andreyevich Laka ◽  
Stepan Petrovich Balashov
Keyword(s):  
Pain Syndrome ◽  
Repeat Surgery ◽  
Septic Complications ◽  
Fracture Group ◽  
Scoliotic Deformity ◽  
Harrington Rod ◽  
Scoliosis Correction ◽  
Reduction Of Pain ◽  
Grade Iii

Objective. To analyze the results of idiopathic scoliosis correction with instrumentation developed by the authors in patients previously operated by the Harrington method. Material and Methods. Ten patients of 14–31 years of age with grade III–IV scoliotic deformity previously operated by the Harrington method were reoperated with universal endocorrector. The reasons for repeat surgery included a fracture of Harrington rod, insufficient correction of scoliotic deformity, perforation of the vertebral arch by distractor hook, and the trunk imbalance. All patients underwent simultaneous two-stage surgery involving distractor removal and scoliosis correction with universal endocorrector. The follow-up period was 6–24 months. Results. Mean correction in rod fracture group was 61.08 % without complications, in undercorrection group (mean correction 27.24 %) it achieved 63.39 %. In the group of patients with vertebra arch penetration and pain syndrome the mean correction by universal endocorrector was 34.29 % with 100 % reduction of pain. During the 6–24 months follow- up there were no correction loss or neurologic and septic complications in operated patients. Conclusions. The new instrumentation provides greater correction (1.8 times) of scoliotic deformity than Harrington rod instrumentation. It is successfully used in repeat surgery and equally effective both in adolescent and in adult scoliosis.

scholarly journals Paradoxical response in spinal tuberculosis: Lessons learnt

2016 ◽  
Vol 07 (02) ◽  
pp. 206-209 ◽  
Author(s):  
Kiranchand Velivela ◽  
Alugolu Rajesh
Keyword(s):  
Weight Gain ◽  
Surgical Intervention ◽  
Spinal Tuberculosis ◽  
Surgical Decompression ◽  
Neurological Deficits ◽  
Ultrasound Guided ◽  
Paradoxical Response ◽  
Antituberculous Treatment ◽  
Leukocyte Counts

ABSTRACT Background: Patients with spinal tuberculosis started on antituberculous treatment (ATT) empirically and showing increasing size of the lesion on follow-up are a treatment challenge. We describe our experience in managing such cases. Materials and Methods: We treated 80 patients with spinal tuberculosis at our institute from January 2012 to June 2014. Of these, 50 were managed by surgical intervention and the rest 30 were managed conservatively only on anti-tubercular drugs. Six patients out of these 30 patients, showed a paradoxical increase in the size of lesion without any neurological deficits after 3 months of starting ATT. Surgical intervention was done in three cases, whereas other three were managed by ultrasound-guided tapping of the lesion with continuation of ATT. Results: There was an improvement in the symptoms with weight gain and normalcy of appetite. However, all these patients had lymphopenia on differential leukocyte counts at the outset which normalized at 3 months. Conclusion: The mainstay of management of paradoxical response in spinal tuberculosis should be conservative with drainage or aspiration of abscesses along with the continuation of ATT. Surgical decompression and stabilization may be necessary in few cases who develop new neurological deficits or deformity or instability.

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