Real-time ultrasound-guided epidural anesthesia for cesarean section in a parturient with achondroplasia

Achondroplasia is a type of disproportionate dwarfism with short limbs and a normal-sized torso. This condition results in a potential spinal abnormality and a difficult airway may increase the anesthetic risk, not only in neuraxial anesthesia, but also in general anesthesia. We report a 25-year-old primigravida with achondroplasia who underwent cesarean section under epidural anesthesia with the assistance of real-time ultrasound guidance. A total dose of 17 mL 2% lidocaine with 7.5 μg sufentanil was administered via epidural catheter intermittently. The level of anesthesia reached T4. No other anesthetic was administered during the operation and the procedure was uneventful. The mother and her newborn were routinely discharged without any adverse events. During the follow-up at 10 months postoperatively, the patient did not have any discomfort. We suggest that titrated epidural anesthesia at the time of real-time ultrasound-guidance is a safe and effective epidural anesthesia for patients with achondroplasia.

Prenatal diagnosis of fetal hemivertebra in the first trimester

Hemivertebra is a congenital spinal abnormality. The condition may affect one or multiple vertebrae. Hemivertebra occurs because of malformations or absence of the ossification centers. Most cases reported in the literature are diagnosed in the second trimester, usually after 22 weeks. It is very unusual and difficult for the hemivertebra to be detected at the first trimester.

Analysis of Proximal Femoral Parameters in Adolescent Idiopathic Scoliosis

Background. Assessment of the proximal femoral parameters in adolescent idiopathic scoliosis using three-dimensional radiological image reconstructions may allow better characterization than conventional techniques. Methods. EOS 3D reconstructions of spines and femurs of 320 scoliotic patients (10-18 years old) and 350 control children lacking spinal abnormality were performed and 6 proximal femoral parameters measured. Results. Individuals with adolescent idiopathic scoliosis showed a small but statistically significant decrease in neck shaft angle (average difference=2.58°) and a higher (0.22°) femoral mechanical axis–femoral shaft angle. When the two sides were compared based on curve direction, greater changes in the neck shaft angle and femoral mechanical axis–femoral shaft angle were found on the side of the convexity. Conclusions. Patients with adolescent idiopathic scoliosis were found to have a small but significantly lower neck shaft angle and higher femoral mechanical axis–femoral shaft angle, which related to the curve direction. This is postulated to be due to mechanical compensation for altered balance and centre of gravity associated with a scoliosis deformity, although the observed difference likely has negligible clinical effect.

P89 Spinal disease in neurofibromatosis type 1 (NF1): a systematic review to evaluate reported patterns of pathology

ObjectivesTo describe the characteristics of reported spinal pathology in NF1 patients.DesignSystematic review.Subjects1809 patients from 23 studies.MethodsThis review was conducted as per PRISMA guidelines and registered on the PROSPERO database of systematic reviews. Systematic searches were performed on the following databases: PubMed, PsycINFO, Medline, HMIC, HBE, EMBASE, CINAHL, BNI, AMED and the Cochrane Database of Systematic Reviews. Studies with n>1 describing any spinal abnormality in NF1 patients were included.Results23 studies were included from 1253 unique results. The evidence levels were as follows: I (n=1), II (n=2) and IV (n=19). Data was available in 1809 patients with a mean age of 22.5 years and equal gender distribution (49.3% male). Reported spinal pathology included: dural ectasia – 93/290 (32.1%); scoliosis – 326/748 (43.6%); meningocele – 5/31 (16.1%); syrinx – 10/97 (10%); cord signal abnormalities in the absence of tumour compression – 33/97 (34%); intramedullary tumour – 7/82 (8.5%); spinal nerve root tumour – 276/1350 (20.4%); and spinal plexiform tumour – 167/364 (45.9%). Degenerative spinal disease and Chiari malformation were not described to any meaningful extent.ConclusionsSpinal pathology is common in patients with NF1 though existing literature is heterogeneous in how findings are presented. Most existing studies are of low quality. There is a need for prospective studies on this theme to aid the establishment of a core outcome set for spinal disease in NF1 patients.

PREVALENCE OF SCOLIOSIS IN ELEMENTARY SCHOOL STUDENTS AGED 8-11 YEARS

Adolescent idiopathic scoliosis (AIS) is a spinal abnormality commonly found in children and adolescents with a prevalence rate of 0.5-5.2%. Data on scoliosis in Indonesia is yet to be available. Our study was aimed at screening and comparing school children with normal posture and with suspected scoliosis (SS). 1059 elementary school students (477 boys, 582 girls) from grade 3 to grade 6 in Jakarta participated in this study. Body mass and height were measured according to the standard technique. Axial rotation of the spine was measured using a scoliometer. Results were classified into two groups: normal if the axial rotation angle was <5° and scoliosis was suspected if the angle was ≥5°. An independent t-test was used to analyze anthropometric differences between the normal and SS group. Statistical significance was set at p<0.05. 74 (7%) of the 1059 students were SS, consisting of 24 (5 %) boys and 50 (8.6 %) girls (OR 1.98, P=0.004). Students at the age of 10 had the highest incidence of scoliosis (27 or 10.1%). Girls with SS were significantly taller and with lower BMI values (138.6 cm vs 134.6 cm, p=0.014; 16.95 kg/m2 vs 18.50 kg/m2, p=0.028). The scoliosis rate in elementary students in Jakarta was about 7 % with higher prevalence in girls.

Anesthesia management of patient with achondroplasia for abdominal hysterectomy

<p class="abstract">Achondroplasia is the commonest form of dwarfism. These patients present several problems for both general and regional anesthesia. There are reports describing regional anesthesia in such patients but there are scarce reports of general anesthesia. The aim of this report is to discuss anesthetic considerations in such patients and to emphasize the difficulties encountered. A 34 year old patient with achondroplasia underwent abdominal hysterectomy under general anesthesia supplemented with regional analgesia. Since preoperative assessment suggested difficult airway, regional anesthesia was planned which was not successful due to spinal abnormality. Subsequently general anesthesia was established with Laryngeal Mask Airway (LMA) with controlled ventilation without any complication.</p>

Spinal subdural abscess following epidural steroid injection

The authors report the case of a 58-year-old man who presented with a cervicothoracolumbosacral spinal subdural abscess about a month after receiving an epidural steroid injection for management of low-back pain due to L5–S1 disc herniation. Although he presented with symptoms concerning for a spinal etiology, the subdural empyema was not evident on the initial MRI study and was observed on imaging 5 days later. This patient was successfully managed with surgical intervention and antibiotic treatment, and he is doing well more than 21 months after the operation. It is possible that a prior history of disc herniation or other spinal abnormality may increase a patient's risk of developing spinal subdural empyema. This case illustrates the risk of infection following spinal epidural steroid injections and the importance of early recognition and intervention to successfully treat an extensive subdural abscess.

Spinal segmental dysgenesis

Spinal segmental dysgenesis is a rare congenital spinal abnormality , seen in neonates and infants in which a segment of the spine and spinal cord fails to develop normally . The condition is segmental with normal vertebrae above and below the malformation. This condition is commonly associated with various abnormalities that affect the heart, genitourinary, gastrointestinal tract and skeletal system. We report two cases of spinal segmental dysgenesis and the associated abnormalities.

SPINAL DEFORMITY

ABSTRACT OBJECTIVE In this literature review, the authors analyze data from previously published studies that evaluated neutral upright spinal alignment (NUSA) from the occiput to the pelvis in asymptomatic individuals. Based on the data for NUSA in asymptomatic volunteers, a new classification is proposed for spinal deformity. METHODS A review of the English literature was conducted to identify studies evaluating NUSA from the occiput to the pelvis in asymptomatic juvenile, adolescent, adult, and geriatric volunteers. From the literature review, 17 angles and displacements were selected to depict neutral upright coronal and axial spinal alignment, and 21 angles and displacements were selected to depict neutral upright sagittal spinal alignment. Pooled estimates of the mean and variance were calculated for the angles and displacements from the articles that met inclusion criteria. A new classification of spinal deformity was then developed based on age-dependent NUSA; spinal abnormality; deformity curve location, pattern, magnitude, and flexibility; and global spinal alignment. RESULTS Despite a wide variation in the regional curves from the occiput to the pelvis in asymptomatic volunteers, global spinal alignment is maintained in a narrow range for preservation of horizontal gaze and balance of the spine over the pelvis and femoral heads. CONCLUSION A new classification of spinal deformity is proposed that provides a structure for defining deformity of all patient ages and spinal abnormalities.