Thoracic Endovascular Aortic Repair for Iatrogenic Injury of the Thoracic Aorta

Purpose: Address iatrogenic injury to the descending thoracic aorta by breached spinal screws through a novel approach of concomitant spinal screw removal and thoracic endovascular repair (TEVAR) placement. Case Report: A 36-year-old female with idiopathic scoliosis underwent T4 to L3 bilateral pedicle instrumentation with spinal fusion and correction of scoliosis deformity. Ten months post-operative, she continued to complain of mid-thoracic pain; computed tomography (CT) angiography revealed protrusion of the left T5 and T6 transpedicular screws into her descending thoracic aorta by 3 and 5 mm, respectively. She was taken to the odds ratio (OR) in a combination case with vascular and neurosurgery. Positioned in the right lateral decubitus position, TEVAR was successfully deployed while neurosurgery concurrently removed the invading spinal screws via posterior spinal exposure. Neurosurgery then completely revised the spinal hardware during the same operation. The patient progressed well throughout the remainder of her hospital stay and was discharged on postoperative day 4. Two-year angiography demonstrated a well-placed TEVAR with no extravasation or aortic abnormality. Conclusions: In the setting of iatrogenic aortic injury due to pedicle screws, concomitant TEVAR and spinal screw removal is a safe and feasible treatment option that allows for spinal reconstruction to occur without multiple trips to the operating room.

Diagnosis and conservative treatment of adolescent idiopathic scoliosis

Background: Adolescent idiopathic scoliosis (AIS) has a diagnosis rate of 3% to 5% per year, but the number of cases requiring surgical treatments is very small, accounting for only 0.17% to 1.75% of all AIS patients. Most patients with AIS are diagnosed, treated, and managed in outpatient clinics.Current Concepts: AIS is a disease that occurs more frequently, and progresses faster, in females than in males. Scoliosis deformity can occur due to various causes. To differentially diagnose AIS, it is necessary to perform careful physical examinations, investigate family history, and check for neurological, growth, and developmental abnormalities. Definitive diagnosis of AIS can be performed through radiographic imaging. In the case of atypical curvature and symptoms, examinations such as magnetic resonance imaging could be required in addition to radiographic imaging. Treatment of AIS patients in outpatient clinics can be performed through observation, exercise, and orthosis. The selection and application of treatment methods and the termination period of the treatments are complexly affected by the age at the time of diagnosis; pattern, location and size of the curve; and growth potential.Discussion and Conclusion: AIS is a disease in which good results can be obtained with conservative treatments such as exercise and orthosis, which is generally applied in an outpatient setting. To properly treat AIS, it is necessary to have an in-depth understanding of the characteristics of AIS, timing of treatment, and factors influencing treatment.

Anesthetic Management of Scoliosis Correction in Mainzer-Saldino Syndrome: A Case Report

Introduction: Mainzer-Saldino Syndrome is a rare autosomal recessive disease with mutations in genes that encode components involved in ciliary transport. This syndrome is characterized by chronic renal failure, severe retinal dystrophy and skeletal abnormalities including spinal and chest wall deformity resulting in severe respiratory failure. Case presentation: We report the first successful anesthetic management of a 26-year-old man with Mainzer-Saldino Syndrome who underwent scoliosis deformity surgical correction. The severity of respiratory problems and renal dysfunction that characterize this syndrome require a multidisciplinary preoperative assessment and careful planning of intraoperative management, also in relation to surgical complications. Conclusions: A careful preoperative assessment is essential for the correct anesthetic management. General anesthesia was safely administered; however a constant modulation of controlled ventilation is required to avoid barotrauma and an invasive hemodynamic monitoring is critical to allow adequate fluid management. Lastly, intraoperative dialysis can be planned in long-lasting surgery with a significant loss and replacement of fluids. Keywords: Mainzer-Saldino Disease; Ciliopathy; Anaesthesia.

Stress Analysis of Thoracolumbosacral Orthosis (TLSO) for Scoliosis deformity and its Effects on Gait Cycle

This work involved two major parts: the first one is the experimental part which included treatment of scoliosis deformity by manufacturing thoracolumbosacral orthosis, measuring the cobb angle of deformity, measuring the gait cycle data and walk path for both legs and suggesting a composite material to improve the mechanical properties of the orthosis and finally the interface pressure between trunk and orthosis is measured for twelve points covering of the total TLSO surface area by using f-socket devise. The second part of this study is the numerical simulation part during which the stresses are calculated using Ansys software for calculating stresses due to interface pressure loading boundary condition. The result shows no deference in gait cycle phases but the clear difference noted in walking path due to deviate center of mass, maximum pressure recorded left thoracic region with 900KPa due to correct spinal deformity while the minimum pressure recorded at right chest with l40KPa because of it is tissue region and Maximum value of stress was recorded at the left thoracic region with 2.81MPa due to Maximum interface pressure at this point.

Skeletal Deformity of Scoliosis in Gilthead Seabreams (Sparus aurata): Association with Changes to Calcium-Phosphor Hydroxyapatite Salts and Collagen Fibers

The development of skeletal deformities in seabream farming affects fish growth, survival, and production costs. Collagen distribution in different fish tissues might be correlated with swimming behavior. This study investigates whether scoliosis in seabreams is associated with changes to calcium-phosphor hydroxyapatite salts and collagen fibril morphology. Samples of decalcified vertebrae of scoliotic and non-scoliotic seabreams were examined with transmission electron microscopy and collagen micrographs were taken and analyzed. The mineral content, modulus of elasticity, and morphology of the vertebrae were also determined. The results indicated that fish with scoliosis had significant smaller mean vertebral collagen fibril diameters than the controls. Vertebrae in abdominal and caudal regions of the scoliotic seabreams appeared to be smaller than the respective vertebrae of the non-deformed seabreams. The calcium (Ca) and phosphorus (P) amounts of vertebrae of both scoliotic and non-scoliotic seabreams were not affected by the scoliosis deformity. The modulus of elasticity showed that the vertebrae from seabreams with scoliosis were more flexible than the vertebrae from seabreams without any skeletal deformity. The mechanical properties of bone are crucially dependent on collagen structure. Hence, how the vertebral column collagen of juvenile fish is related to the mechanism of deformities requires further investigation in order to provide a risk-reducing strategy to increase fish performance in aquaculture.