Halo-gravity traction in the treatment of complex spinal deformities in children with respiratory dysfunctions

HGT is a safe technique as the world literature describes complications in the form of loosening of the pins or superficial infections of the skin around the pins, which are not significant and do not pose a threat to the patient’s life. Purpose – to improve the results of the ventilation function of the lungs in patients with complex spinal deformities through the preliminary use of halo gravity traction and to introduce an effective and safe method for the treatment of complex spinal deformities in children with respiratory dysfunctions. Materials and methods. 64 children with complex spinal deformities (>100°) were treated in the orthopedic and traumatology department of the Okhmatdet NSPU using halo gravity traction during the period from 2003 until 2018. Of these, 38 are boys and 26 are girls. The average age of the patients was 11.6 years. The average Risser score was 3.8 (P>0.01). Results. According to the data of spirography performed, 46% of patients had moderate ventilation disorders and 54% – severe ventilation disorders (FVC<60% – grade 3 and 4 of ventilation failure). Mixed type disorders were recorded in 83% of patients, and restrictive type disorders in 17% (8/48) of children. After HGT, there was an improvement in pulmonary function indicators: an increase in FVC from 63.19% to 71.77% and FEV1 from 54.71% to 65.46%, Tiffeneau-Pinelli index – from 74.59% to 85.33%. Compared with the initial level of indicators, the improvement in FVC was 13.6% after HGT and 14.6% in dynamics during the year, and FEV1 – 19.6% and 21.6%, respectively. The results obtained indicate a significant improvement in the ventilation function of the lungs, especially due to the degree of FEV1 increase, which correlates with the degree of improvement in performance, mortality and life prognosis. Conclusions. The use of HGT makes it possible to improve the results of the final correction of spinal deformity, which in turn significantly improves the ventilation function of the lungs, which in turn helps to reduce the risks of mortality due to pulmonary insufficiency in adulthood. The choice of the appropriate methods of surgical correction for complex deformity of the spine is a prerequisite for successful treatment and the achievement of three-dimensional correction of the spine to maximally approximate its parameters to the physiological norm. The indication for halo gravity traction is a rigid scoliotic deformity of the spine with a deformity angle (>100°). This study was conducted in accordance with the principles of the Helsinki Declaration. The research protocol was approved by the Local Ethics Committee of the institutions mentioned in the work. Informed parental agreement was obtained for the research. No conflict of interests was declared by the authors. Key words: spinal deformity, respiratory dysfunctions, halo-gravity traction.

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BIPLANAR IMAGING WITH TRIDIMENSIONAL CAPABILITIES: APPLICABILITY OF THIS NEW EXAMINATION TO SPINAL DEFORMITIES

Coluna/Columna ◽

10.1590/s1808-185120201901222631 ◽

2020 ◽

Vol 19 (1) ◽

pp. 67-70

Author(s):

RAPHAEL DE REZENDE PRATALI ◽

MURILO TAVARES DAHER ◽

ROBERT MEVES

Keyword(s):

Spinal Deformity ◽

Imaging System ◽

Adult Spinal Deformity ◽

Three Dimensional ◽

Entire Body ◽

Spinal Deformities ◽

Compensatory Mechanisms ◽

Level Of Evidence ◽

The Individual ◽

Bone Structures

ABSTRACT This study presents details about the applicability of the new image acquisition system, called the biplanar imaging system, with three-dimensional capabilities (EOS®) to the treatment of spinal deformities. This system allows radiographic acquisition of the entire body, with a great reduction in the dose of radiation absorbed by the patient and three-dimensional (3D) stereoradiographic image reconstruction of bone structures, including the spine. In the case of adolescent idiopathic scoliosis, the analysis of the spinal deformity with 3D reconstruction allows better understanding of the deformity and surgical planning. In the case of adult spinal deformity, full-body analysis allows an evaluation of the spinopelvic deformity, including loss of sagittal alignment, in addition to an evaluation of compensatory mechanisms recruited by the individual in an attempt to maintain the sagittal balance. Level of evidence III; Descriptive Review.

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Three-Dimensional Printing for Preoperative Planning and Pedicle Screw Placement in Adult Spinal Deformity: A Systematic Review

Global Spine Journal ◽

10.1177/2192568220944170 ◽

2020 ◽

pp. 219256822094417

Author(s):

Cesar D. Lopez ◽

Venkat Boddapati ◽

Nathan J. Lee ◽

Marc D. Dyrszka ◽

Zeeshan M. Sardar ◽

...

Keyword(s):

Systematic Review ◽

Spinal Deformity ◽

Adult Spinal Deformity ◽

Three Dimensional ◽

Deformity Correction ◽

Screw Placement ◽

Spinal Deformities ◽

Three Dimensional Printing ◽

Significant Difference ◽

Dimensional Printing

Study Design: Systematic review. Objectives: This current systematic review seeks to identify current applications and surgical outcomes for 3-dimensional printing (3DP) in the treatment of adult spinal deformity. Methods: A comprehensive search of publications was conducted through literature databases using relevant keywords. Inclusion criteria consisted of original studies, studies with patients with adult spinal deformities, and studies focusing on the feasibility and/or utility of 3DP technologies in the planning or treatment of scoliosis and other spinal deformities. Exclusion criteria included studies with patients without adult spinal deformity, animal subjects, pediatric patients, reviews, and editorials. Results: Studies evaluating the effect of 3DP drill guide templates found higher screw placement accuracy in the 3DP cohort (96.9%), compared with non-3DP cohorts (81.5%, P < .001). Operative duration was significant decreased in 3DP cases (378 patients, 258 minutes) relative to non-3DP cases (301 patients,272 minutes, P < .05). The average deformity correction rate was 72.5% in 3DP cases (245 patients). There was no significant difference in perioperative blood loss between 3DP (924.6 mL, 252 patients) and non-3DP cases (935.6 mL, 177 patients, P = .058). Conclusions: Three-dimensional printing is currently used for presurgical planning, patient and trainee communication and education, pre- and intraoperative guides, and screw drill guides in the treatment of scoliosis and other adult spinal deformities. In adult spinal deformity, the usage of 3DP guides is associated with increased screw accuracy and favorable deformity correction outcomes; however, average costs and production lead time are highly variable between studies.

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Progressive Scoliosis and Syringomyelia - Questions of Surgical Approach

Folia Medica ◽

10.1515/folmed-2017-0099 ◽

2018 ◽

Vol 60 (2) ◽

pp. 261-269 ◽

Cited By ~ 1

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.

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Three-Dimensional Terminology of Spinal Deformity

Spine ◽

10.1097/00007632-199401001-00020 ◽

1994 ◽

Vol 19 (Supplement) ◽

pp. 236-248 ◽

Cited By ~ 311

Author(s):

Ian A. F. Stokes

Keyword(s):

Spinal Deformity ◽

Three Dimensional

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Broken rods in spinal deformity surgery: an analysis of clinical experience and a literature review

Pediatric Traumatology Orthopaedics and Reconstructive Surgery ◽

10.17816/ptors7415-26 ◽

2020 ◽

Vol 7 (4) ◽

pp. 15-26

Author(s):

Mikhail V. Mikhaylovskiy ◽

Alexander S. Vasujra ◽

Vitaliy L. Lukinov

Keyword(s):

Literature Review ◽

Spinal Deformity ◽

Congenital Scoliosis ◽

Study Groups ◽

Lower Percentage ◽

Reference List ◽

Spinal Deformities ◽

Significant Difference ◽

Spinal Deformity Surgery ◽

Rod Fracture

Backgrоund. Rod fractures are one of the specific complications of spinal deformity surgery. The number of publications on this topic is small, and the conclusions are often contradictory. Aim. The aim of this study is to analyze the current situation concerning the problem of fractures of the rods in spinal deformities of various etiologies in terms of frequency and risk factors for this complication. Materials and methods. The study included 3,833 patients who underwent operations between 1996 and 2018. The inclusion criteria of being over 10 years of age with no history of spinal surgery were applied. Results. Fractures of metal implant rods were detected in 85 patients out of a total of 3,833 (2.2%). There was a significant difference between the groups of idiopathic and congenital scoliosis patients. A rod fracture in 62 of the 85 patients was the reason for reintervention to restore integrity with a connector or a full replacement. An increase in BMI by one raised the chance of a fracture by 1.07 times (p = 0.019). Increasing the age by one year increased the possibility of a fracture by 1.03 times (p = 0.039). A statistically significant association of the ventral stage of surgical treatment (discectomy and interbody fusion with autologous bone) where no fracture was detected (p = 0.403) was revealed. Being over 15 years old a statistically significant predictor was in the group under 20 years of age (p = 0.048). For BMI, there was no statistically significant threshold for fracture probability in the group under 20 years of age. It was confirmed that a hybrid fixation system produced a significantly lower percentage of complications than a hook system. A systematic literature review of sources on this topic included international databases (Scopus, Medline, and Google Scholar) as well as investigating the publications contained in the reference list. Conclusions. Rod fractures during surgery for spinal deformities of various etiologies are one of the typical complications. Fracture frequency in large study groups is small. The risk of developing this complication rises with both increasing BMI and patient age, although there is no statistically significant threshold for BMI relative to the chances of fracture in the group up to 20 years of age. Modern reticular systems of attachment of the endocorrector to the vertebral structures can dramatically reduce the risk of rod fracture during the postoperative period.

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Exploring units-locating in enumerating units of 3D arrays: linking units-locating to units-representation

Mathematics Education Research Journal ◽

10.1007/s13394-021-00405-7 ◽

2021 ◽

Author(s):

Edgar Alstad ◽

Maren Berre ◽

Per Nilsson

Keyword(s):

Three Dimensional ◽

Grade 3 ◽

Support Students

AbstractThe aim of the present study is to explore strategies in enumerating units of three dimensional (3D) arrays. We analyse enumeration strategies of students in grade 3 (ages 8 to 9) in situations of cubical and spherical representations of units of 3D arrays. By exploring students’ strategies in these two situations, we find that difficulties in enumerating units in 3D arrays can be traced to difficulties in units-locating, with the consequence of applying double and triple counting. Our results also indicate that spherical units can serve as perceptual clues in units-locating and in assembling units into relevant composites. With input from our findings, we suggest research to investigate the following three hypotheses: (i) spherical units can turn students away from double and triple counting, (ii) spherical units can support students’ units-locating process and their ability to assemble units into relevant composites and (iii) teaching of enumerating 3D arrays should start with spherical units before cubical units.

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Thoracic kyphosis and pelvic anteversion in patients with adult spinal deformity increase while walking: analyses of dynamic alignment change using a three-dimensional gait motion analysis system

European Spine Journal ◽

10.1007/s00586-020-06312-y ◽

2020 ◽

Vol 29 (4) ◽

pp. 840-848 ◽

Cited By ~ 1

Author(s):

Kousei Miura ◽

Hideki Kadone ◽

Masao Koda ◽

Tetsuya Abe ◽

Toru Funayama ◽

...

Keyword(s):

Motion Analysis ◽

Spinal Deformity ◽

Thoracic Kyphosis ◽

Adult Spinal Deformity ◽

Three Dimensional ◽

Motion Analysis System ◽

Analysis System ◽

Dynamic Alignment

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Results of a Phase II Study Using Estramustine Phosphate and Vinblastine in Combination With High-Dose Three-Dimensional Conformal Radiotherapy for Patients With Locally Advanced Prostate Cancer

Journal of Clinical Oncology ◽

10.1200/jco.2000.18.9.1936 ◽

2000 ◽

Vol 18 (9) ◽

pp. 1936-1941 ◽

Cited By ~ 46

Author(s):

Michael J. Zelefsky ◽

William K. Kelly ◽

Howard I. Scher ◽

Henry Lee ◽

Tracy Smart ◽

...

Keyword(s):

Prostate Cancer ◽

Gleason Score ◽

Three Dimensional ◽

Conformal Radiotherapy ◽

High Dose ◽

Estramustine Phosphate ◽

Risk Prostate Cancer ◽

Grade 3 ◽

Three Dimensional Conformal Radiotherapy ◽

3D Crt

PURPOSE: To assess the feasibility and tolerance of neoadjuvant and concomitant estramustine phosphate and vinblastine (EV) with high-dose three-dimensional conformal radiotherapy (3D-CRT) for patients with unfavorable-risk prostate cancer. PATIENTS AND METHODS: Twenty-seven patients with unfavorable-risk prostate cancer were enrolled onto a prospective study to determine the feasibility of combining EV with 3D-CRT. Patients were eligible if any of the following requirements were satisfied: (1) Gleason score ≥ 8 and prostate-specific antigen (PSA) > 10 ng/mL; (2) Gleason score of 7 and PSA > 20 ng/mL; (3) clinical stage T3N0M0 disease with PSA > 20 ng/mL; (4) any patient with T4N0M0 disease; or (5) patients with TXN1MO disease. Therapy consisted of three 8-week cycles of EV and 8 weeks of 3D-CRT. Estramustine phosphate was given orally beginning on week 1 and continued until the completion of 3D-CRT. Each 8-week cycle of vinblastine consisted of 6 weekly intravenous injections followed by a 2-week rest period. Radiation therapy was administered using a three-dimensional conformal approach to a prescription dose of 75.6 Gy. The median follow-up was 26 months (range, 6 to 40 months). RESULTS: Twenty-three (85%) of 27 patients completed the entire course of therapy and were assessable for toxicities and biochemical outcome. Two patients (7%) developed grade 3 hematologic toxicity that resolved, and two patients (7%) developed grade 3 hepatoxicity, manifesting as persistent elevation of serum transaminase levels, necessitating discontinuation of the chemotherapy and withdrawal from the treatment program. The most prominent adverse effects from this regimen were mild to moderate (grade 1 to 2) nausea and fatigue related to estramustine. Mild peripheral edema was seen in 15% of patients and was treated with diuresis. 3D-CRT was tolerated well in these patients. Medications were required for relief of acute grade 2 rectal (gastrointestinal [GI]) and urinary (genitourinary [GU]) symptoms in 35% and 48% of patients, respectively. Three patients developed acute grade 3 GU toxicities. The 2-year actuarial likelihood of late grade 2 GI toxicity was 20%. No late grade 3 or 4 GI toxicities were observed. The 2-year actuarial likelihoods of late grade 2 and 3 GU toxicities were 25% and 12%, respectively. No grade 4 GU toxicity was observed. CONCLUSION: Neoadjuvant and concomitant EV with high-dose 3D-CRT is well tolerated in patients with unfavorable-risk prostate cancer. Although the incidence of modest (grade 2) late GI and GU toxicities seem to be increased compared with 3D-CRT alone or in combination with androgen ablation therapy, no severe toxicities were encountered with this regimen.

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Classification of Pituitary Adenomas Invading the Cavernous Sinus Assisted by Three-Dimensional Multimodal Imaging and Its Clinical Application

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0040-1715597 ◽

2020 ◽

Author(s):

Yukun Zhang ◽

Shaohua Tu ◽

Lian Duan ◽

Weilun Fu ◽

Jianbo Wang ◽

...

Keyword(s):

Cavernous Sinus ◽

Pituitary Adenomas ◽

Multimodal Imaging ◽

Three Dimensional ◽

Lateral Wall ◽

Lateral Compartment ◽

Posterior Compartment ◽

Grade 3 ◽

Distinct Separation

Abstract Introduction To help diagnose and evaluate the prognosis of pituitary adenoma with cavernous sinus (CS) invasion and guide endonasal endoscopic surgery (EES) assisted by intraoperative navigation (ION) with three-dimensional multimodal imaging (3D-MMI). We propose a classification of CS invasion based on 3D-MMI. Methods We picked some appropriate cases and reconstructed the 3D-MMI and then classified them into 3 grades according to the stereo relationship among ICA, tumor and CS in 3D-MMI. Then, we applied different strategies according to their grade to remove pituitary adenomas that invaded the CS. Results All 38 patients were divided into 3 grades. Tumors compressing the ICA and CS without CS invasion were divided into grade 1. Tumors encasing the ICA and invading the superior-posterior compartment and/or anterior-inferior compartment but without distinct separation of the ICA and CS lateral wall were deemed as grade 2. Tumors encasing the ICA and filling the lateral compartment of the CS that dissociated the lateral wall from the ICA were deemed as grade 3. The 3D-MMI enabled adequate spatial visualization of the ICA, CS and tumors. All patients were operated on under the guidance of ION with 3D-MMI. Conclusions Classification based on 3D-MMI can better demonstrate the relationships among tumor, ICA and CS in a stereo and multi-angle view, which will have significance in guiding the surgical strategy.

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