scholarly journals GAIT DISORDERS IN PATIENTS WITH INSTRUMENTED NEUROMUSCULAR SCOLIOSIS

2019 ◽  
Vol 18 (4) ◽  
pp. 272-275
Author(s):  
Carlos Duncan ◽  
Sebastian Maenza ◽  
Cecilia Schmid ◽  
Eduardo Segal ◽  
Juan Couto
Keyword(s):  
Spinal Fusion ◽  
Spinal Instrumentation ◽  
Posterior Spinal Fusion ◽  
Neuromuscular Scoliosis ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Age At Surgery ◽  
Ambulatory Patients ◽  
Control Study

ABSTRACT Introduction: The effect of spinal fusion on gait in patients with neuromuscular scoliosis continues to be a controversial issue, especially in patients where the spinal fusion extends to the pelvis. Objective: To evaluate the effect of spinal instrumentation in these patients. Methods: We evaluated 34 patients in a retrospective study. The mean age at surgery was 14±3 years and only ambulatory patients who presented neuromuscular scoliosis and non-progressing neurogenic pathology were included. The patients were surgically treated by posterior spinal fusion with or without extension to the pelvis. Preoperative (PRE) and postoperative (POP) Rx were measured. Ambulatory potential was clinically examined in all the patients, and 10 patients were assessed by full-gait analysis. Results: The minimum POP follow-up was 2 years (2006-2016). Nine patients were instrumented to the pelvis when the obliquity was greater than 15°; the remaining patients were treated using the same fusion-level criteria as those applied for idiopathic scoliosis. All patients maintained their gait, with improvements in coronal and sagittal balance, transfers and sitting skills, physical appearance, and in some cases, gait speed. Conclusions: Spinal instrumentation in ambulatory patients with neuromuscular scoliosis, including procedures with extension to the pelvis, provides adequate correction and preserves ambulatory function. Level of evidence III; Retrospective case control study.

scholarly journals Sublaminar polyester band fixation construct in the treatment of neuromuscular scoliosis

2019 ◽  
Vol 13 (4) ◽  
pp. 393-398
Author(s):  
S. Rosenfeld ◽  
S. Kenney ◽  
E. Rebich
Keyword(s):  
Blood Loss ◽  
Pedicle Screws ◽  
Posterior Spinal Fusion ◽  
Pelvic Obliquity ◽  
Neuromuscular Scoliosis ◽  
Level Of Evidence ◽  
Fixation Techniques ◽  
Clinical Records ◽  
Sublaminar Bands

Purpose Multiple fixation techniques exist for treating progressive neuromuscular scoliosis including pedicle screws, sublaminar bands/wires, hooks or a combination of instruments. Most sublaminar band constructs are supplemented with pedicle screws, hooks and/or sublaminar wires particularly at the top of the construct. There are no studies to date that describe an all/predominant sublaminar band construct. The purpose of this study was to investigate the outcomes of a sublaminar polyester band construct to treat neuromuscular scoliosis. Methods A retrospective review was conducted of 32 cases of neuromuscular scoliosis treated with posterior spinal fusion using a sublaminar band construct between 2013 and 2016 by a single surgeon at a single centre. Preoperative, immediate postoperative and two-year follow-up radiographs and clinical records were reviewed. Sagittal, coronal and pelvic obliquity correction was measured. Blood loss, length of surgery and complications were recorded. Results In all, 29 patients were included. Mean postoperative coronal plane correction was 57% (0% to 92%) and maintained at two-year follow-up. Mean sagittal balance was 2.3 cm (-2.5 to 6.4). Mean lumbar lordosis angle decreased by 7° (44° to 37°). Mean thoracic kyphosis angle increased by 9° (23° to 32°). Mean pelvic obliquity decreased by 50% (from 15° to 7°). There were four major complications (14%) and eight minor complications (21%). Mean blood loss was 1304 cc (250 cc to 2450 cc). Conclusion Sublaminar polyester band fixation constructs provide a viable option in correction of deformity in patients with neuromuscular scoliosis with comparable outcomes with what is reported with other constructs. Level of Evidence: V

scholarly journals Releasing the tether: Weight normalization following corrective spinal fusion in cerebral palsy

2018 ◽  
Vol 26 (2) ◽  
pp. 230949901878255 ◽  
Author(s):  
Christopher J DeFrancesco ◽  
Daniel J Miller ◽  
Patrick J Cahill ◽  
David A Spiegel ◽  
John M Flynn ◽  
...  
Keyword(s):  
Regression Analysis ◽  
Cerebral Palsy ◽  
Weight Gain ◽  
Spinal Fusion ◽  
Posterior Spinal Fusion ◽  
Abdominal Pressure ◽  
Level Of Evidence ◽  
Feeding Difficulties ◽  
Weight Percentile

Purpose: Feeding difficulties are common among patients with cerebral palsy (CP) and neuromuscular (NM) scoliosis. We theorize that posterior spinal fusion (PSF) reduces intra-abdominal pressure, resulting in improved feeding and subsequent weight gain. We hypothesized that, among nonambulatory patients with CP and NM scoliosis, we would observe significant gain in weight following PSF. Methods: Fifty subjects with nonambulatory CP who underwent PSF for NM scoliosis were included. Age and weight were recorded for the preoperative year; on the day of surgery; and at 6-month, 1-year, and 2-year follow-up. Weights were converted to weight percentiles using CP-specific growth charts. The weight percentile distributions were compared between time points using descriptive statistics as well as regression analysis. Results: The average change in weight from the day of surgery to 2-year follow-up was +3.4 percentiles. Patients who started out under the 50th percentile gained an average of 17.3 percentiles in the first year after PSF ( p = 0.009). Regression analysis showed that patients with baseline weight <50th percentile tended to gain in weight percentile over the first postoperative year ( β = 1.990, p = 0.001). No trend was present among this group prior to surgery ( p = 0.692) or during the second postoperative year ( p = 0.945). No trends were noted prior to or after surgery for patients with baseline weights ≥50th percentile. No significant association was observed between curve severity (measured by preoperative Cobb angle) and weight change. Conclusions: This series is the first to document significant weight gain after PSF for NM scoliosis, supporting the theory that spinal correction improves digestive function. Level of Evidence: Prognostic level II.

LATERAL CAVITATORY APPROACH WITH CIRCUMSPINAL DECOMPRESSION IN TUBERCULOUS SPONDYLITIS: A 5YR FOLLOW-UP STUDY

2019 ◽  
pp. 1-3
Keyword(s):  
Spinal Fusion ◽  
Pedicle Screw ◽  
Spinal Tuberculosis ◽  
Thoracolumbar Spine ◽  
Spinal Instrumentation ◽  
Posterior Spinal Fusion ◽  
Neurological Complications ◽  
Single Stage ◽  
Laboratory Findings

Introduction: Spinal tuberculosis has been managed with various modalities of treatment ranging from only antituberculous drugs to radical surgical extirpation. Opinion is divided on management of Potts Paraplegia with respect to surgical approach to the lesion. Results are conflicting on anterior verses posterior approaches as well combined approach. There is also confusion on to when to do anterior first or to operate from posterior first, in combined approaches. In the present study we present 10 year follow-up of our results, clinical and radiological outcomes, of Single stage Circumspinal decompression and pedicle screw fixation through lateral extracavitatory approach with anterior and posterior spinal fusion in cases of Pott's paraplegia. Methods:The study was a retrospective and prospective follow up of 30 patients with active tuberculosis of thoracolumbar spine with neurological deficit, who underwent posterior spinal instrumentation with lateral extra cavitatory approach with circumspinal decompression and pedicle screw instrumentation. Diagnosis of spinal tuberculosis was made by laboratory findings such as anaemia, elevated ESR, radiological features with typical MR imaging findings. 8 patients had multilevel involvement. Kyphosis of 250 to 550 was present. Circumspinal decompression, correction of kyphosis, anterior and posterior spinal fusion was performed in a single stage. The average follow up was 7.67 years (92 months). Results: The mean kyphosis angle improved from 320 preoperatively to 80 in early follow up, followed by a minor loss of correction of 30. Neurological recovery occurred in 28 patients out of 30 patients. 15 patients recovered from Asia A to AIS E. 13 patients recovered to ASIA D. The visual analog scale and ASIA grade improved in all the cases. Implant failure in the form of rod breakage was seen in 1 patient but with no neurological complications. Conclusion: Drainage of abscess, debridement by extracavitatory route constitutes a less demanding, relatively safe, minimally traumatic operative technique with adequate circumspinal decompression of spinal cord, correction and maintenance of sagittal balance with relatively less morbidity is the added advantage.

scholarly journals Reduction in surgical site infection with suprafascial intrawound application of vancomycin powder in instrumented posterior spinal fusion: a retrospective case-control study

2018 ◽  
Vol 29 (2) ◽  
pp. 193-198 ◽  
Author(s):  
Shoichi Haimoto ◽  
Ralph T. Schär ◽  
Yusuke Nishimura ◽  
Masahito Hara ◽  
Toshihiko Wakabayashi ◽  
...  
Keyword(s):  
Adverse Effects ◽  
Spinal Fusion ◽  
Case Control Study ◽  
Posterior Spinal Fusion ◽  
Study Groups ◽  
Treated Group ◽  
Untreated Group ◽  
Retrospective Case ◽  
Vancomycin Powder ◽  
Control Study

OBJECTIVERecent studies have demonstrated the efficacy of subfascial intrawound application of vancomycin powder in spine surgery in reducing the rate of surgical site infections (SSIs). However, to date no study has evaluated the efficacy and safety of suprafascial application of vancomycin powder in spine surgery. The purpose of this study was to quantify the rate of SSIs after open instrumented posterior spinal fusion with and without application of suprafascial vancomycin powder and to evaluate the rate of vancomycin powder–related local adverse effects.METHODSThe authors conducted a single-center retrospective case-control study of adult patients undergoing open instrumented posterior fusion of the cervical, thoracic, or lumbar spine performed by a single surgeon from January 2010 through December 2016. In March 2013, routine application of 1 g of suprafascial vancomycin powder was started for all cases in addition to standard systemic antibiotic prophylaxis. Baseline demographics and operative data as well as the SSI rates were compared between the study groups. The incidence of vancomycin powder–related adverse effects was analyzed.RESULTSA total of 515 patients (268 in the untreated group and 247 in the treated group) were included in the study. The mean age was significantly higher in the treated group than in the untreated group (58.4 vs 54.4 years, p < 0.01). Operative variables were similar between the study groups. Patients receiving vancomycin powder had a significantly lower infection rate (5.6% in the untreated group vs 0% in the treated group, p < 0.001). No vancomycin powder–related adverse effects were identified in the treated group.CONCLUSIONSRoutine application of suprafascial intrawound vancomycin powder in addition to systemic antibiotic prophylaxis is an easy-to-use, safe, and effective strategy for preventing SSIs after instrumented posterior spinal fusion. Suprafascial application of vancomycin powder could be a valuable alternative to previously reported subfascial distribution, minimizing the risk of local adverse drug reactions.

scholarly journals Risk factors for progressive neuromuscular scoliosis requiring posterior spinal fusion after selective dorsal rhizotomy

2017 ◽  
Vol 20 (5) ◽  
pp. 456-463 ◽  
Author(s):  
Vijay M. Ravindra ◽  
Michael T. Christensen ◽  
Kaine Onwuzulike ◽  
John T. Smith ◽  
Kyle Halvorson ◽  
...  
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Cobb Angle ◽  
Spinal Fusion ◽  
Spinal Deformity ◽  
Posterior Spinal Fusion ◽  
Neuromuscular Scoliosis ◽  
Selective Dorsal Rhizotomy ◽  
Dorsal Rhizotomy

OBJECTIVESelective dorsal rhizotomy (SDR) via limited laminectomy is an effective treatment of lower-extremity spasticity in the pediatric population. Children with spasticity are also at risk for neuromuscular scoliosis; however, specific risk factors for progressive spinal deformity requiring posterior spinal fusion (PSF) after SDR are unknown. The authors’ goal was to identify potential risk factors.METHODSThe authors performed a retrospective cohort study of patients who underwent SDR via limited laminectomy between 2003 and 2014 and who had at least 1 year of follow-up. They analyzed demographic, clinical, and radiographic variables to elucidate risk factors for progressive neuromuscular scoliosis. The primary outcome was need for PSF.RESULTSOne hundred thirty-four patients underwent SDR and had at least 12 months of follow-up (mean 65 months); 48 patients (36%) had detailed pre- and postoperative radiographic data available. The mean age at surgery was 10 years (SD 5.1 years). Eighty-four patients (63%) were ambulatory before SDR, 109 (82%) underwent a single-level laminectomy, and a mean of 53% of the dorsal rootlets from L-1 to S-1 were sectioned. Fifteen patients (11.2%) subsequently required PSF for progressive deformity. Nonambulatory status (p < 0.001) and a preoperative Cobb angle > 30° (p = 0.003) were significantly associated with PSF on univariate analysis, but no statistically significant correlation was found with any clinical or radiographic variable and PSF after SDR on multivariate regression analysis.CONCLUSIONSPatients with preoperative nonambulatory status and Cobb angle > 30° may be at risk for progressive spinal deformity requiring PSF after SDR. These are well-known risk factors for progressive deformity in children with spasticity in general. Although our analysis suggests SDR via limited laminectomy may not significantly accelerate the development of neuromuscular scoliosis, further case-control studies are critical to elucidate the impact of SDR on spinal deformity.

scholarly journals Infection Recurrence in Instrumented Spinal Fusion in Children

2020 ◽  
pp. 219256822093581
Author(s):  
Carlos A. Moyano ◽  
Carlos A. Tello ◽  
Lucas Piantoni ◽  
Ida A. Francheri Wilson ◽  
Eduardo Galaretto ◽  
...  
Keyword(s):  
Spinal Fusion ◽  
Oral Treatment ◽  
Case Series ◽  
Posterior Spinal Fusion ◽  
Retrospective Case ◽  
Intravenous Antibiotic ◽  
Irrigation And Debridement ◽  
Gram Positive Cocci ◽  
Infection Recurrence

Study Design: Level 4 retrospective case series. Objectives: Surgical site infection (SSI) is one of the main complications of instrumented spinal fusion. The aim of our study was to evaluate infection recurrence (same bacteria) or reinfection (different bacteria) in posterior spinal fusion in children. Methods: A retrospective study was conducted to evaluate patients who were successfully treated for SSI after instrumented spinal fusion due to deformity, with irrigation and debridement (I&D) procedures, followed by antibiotic therapy, with a follow-up of at least 2 years. Results: Overall, 29 patients with a mean age of 14 + 3 years were evaluated. Preoperative diagnosis was nonidiopathic scoliosis in 23, idiopathic scoliosis in 5, and Scheuermann’s disease in 1 patient. The etiology was Gram-positive cocci (40.9%), Gram-negative bacilli (27.2%), and polymicrobial infection (31.8%). A mean of 1.5 (1-3) I&D procedures were performed. Intravenous antibiotic treatment was given for a mean of 15.8 (4-86) days, followed by oral treatment for a mean of 335.1 (0-1095) days. Mean follow-up was 5 + 2 years (2 to 14 + 7 years) during which 28 patients were cured (96.6%) and 1 patient developed reinfection (3.4%). This reinfection was treated with oral clindamycin for 6 months. After the infection persisted, the decision was to remove the implants. Conclusions: In this series of 29 pediatric patients who underwent instrumented spinal fusion due to deformity, we reported one case of reinfection (3.4%). Given that 96.6% of infections were resolved, we suggest treatment with I&D procedures with retention of implants to treat acute SSI.

scholarly journals Lateral open wedge calcaneus osteotomy with bony allograft augmentation in adult acquired flatfoot deformity. Clinical and radiological results

2021 ◽  
Author(s):  
Gabriele Colo’ ◽  
Mattia Alessio Mazzola ◽  
Giulio Pilone ◽  
Giacomo Dagnino ◽  
Lamberto Felli
Keyword(s):  
Range Of Motion ◽  
Case Series ◽  
Deformity Correction ◽  
Tibialis Posterior ◽  
Open Wedge ◽  
Foot And Ankle ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Adult Acquired Flatfoot Deformity

Abstract The aim of this study is to evaluate the results of patients underwent lateral open wedge calcaneus osteotomy with bony allograft augmentation combined with tibialis posterior and tibialis anterior tenodesis. Twenty-two patients underwent adult-acquired flatfoot deformity were retrospectively evaluated with a minimum 2-year follow-up. Radiographic preoperative and final comparison of tibio-calcaneal angle, talo–first metatarsal and calcaneal pitch angles have been performed. The Visual Analog Scale, American Orthopedic Foot and Ankle Score, the Foot and Ankle Disability Index and the Foot and Ankle Ability Measure were used for subjective and functional assessment. The instrumental range of motion has been also assessed at latest follow-up evaluation and compared with preoperative value. There was a significant improvement of final mean values of clinical scores (p < 0.001). Nineteen out of 22 (86.4%) patients resulted very satisfied or satisfied for the clinical result. There was a significant improvement of the radiographic parameters (p < 0.001). There were no differences between preoperative and final values of range of motion. One failure occurred 7 years after surgery. Adult-acquired flatfoot deformity correction demonstrated good mid-term results and low recurrence and complications rate. Level of evidence Level 4, retrospective case series.

Plafond Malreduction and Talar Dome Impaction Accelerates Arthrosis After Supination-Adduction Ankle Fracture

2021 ◽  
pp. 107110072110060
Author(s):  
Michael F. Githens ◽  
Malcolm R. DeBaun ◽  
Kimberly A Jacobsen ◽  
Hunter Ross ◽  
Reza Firoozabadi ◽  
...  
Keyword(s):  
Case Series ◽  
High Energy ◽  
Ankle Fractures ◽  
Posttraumatic Arthritis ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Radiographic Findings ◽  
Posttraumatic Arthrosis ◽  
Patient Reported

Background: Supination-adduction (SAD) type II ankle fractures can have medial tibial plafond and talar body impaction. Factors associated with the development of posttraumatic arthritis can be intrinsic to the injury pattern or mitigated by the surgeon. We hypothesize that plafond malreducton and talar body impaction is associated with early posttraumatic arthrosis. Methods: A retrospective cohort of skeletally mature patients with SAD ankle fractures at 2 level 1 academic trauma centers who underwent operative fixation were identified. Patients with a minimum of 1-year follow-up were included. The presence of articular impaction identified on CT scan was recorded and the quality of reduction on final intraoperative radiographs was assessed. The primary outcome was radiographic ankle arthrosis (Kellgren-Lawrence 3 or 4), and postoperative complications were documented. Results: A total of 175 SAD ankle fractures were identified during a 10-year period; 79 patients with 1-year follow-up met inclusion criteria. The majority of injuries resulted from a high-energy mechanism. Articular impaction was present in 73% of injuries, and 23% of all patients had radiographic arthrosis (Kellgren-Lawrence 3 or 4) at final follow-up. Articular malreduction, defined by either a gap or step >2 mm, was significantly associated with development of arthrosis. Early treatment failure, infection, and nonunion was rare in this series. Conclusion: Malreduction of articular impaction in SAD ankle fractures is associated with early posttraumatic arthrosis. Recognition and anatomic restoration with stable fixation of articular impaction appears to mitigate risk of posttraumatic arthrosis. Investigations correlating postoperative and long-term radiographic findings to patient-reported outcomes after operative treatment of SAD ankle fractures are warranted. Level of Evidence: Level IV, retrospective case series.

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