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Birch C, Welch N, Cook D, Hedequist D. Instrumentation using robotics coupled with navigation in pediatric spine deformity surgery: a technical report of sacropelvic instrumentation. Spine Deform 2025:10.1007/s43390-025-01047-6. [PMID: 39891842 DOI: 10.1007/s43390-025-01047-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 01/11/2025] [Indexed: 02/03/2025]
Abstract
PURPOSE This technical report presents the intraoperative experience of using robotic-assisted navigation (RAN) for sacropelvic instrumentation in pediatric spine deformity surgery. METHODS A retrospective review of patients who underwent surgery using RAN for sacropelvic instrumentation at a single institution from 2019 to 2022 was conducted. In cases with screw confirmation imaging, screws were evaluated using the Gertzbein and Robbins classification scale. RESULTS 52 cases were included. Average age at surgery was 14.1 years and 67.3% of patients were female. The most common diagnosis was spondylolisthesis (48.1%). The average major curve in scoliosis cases was 77°. A Schanz pin in the posterior superior iliac spine was placed in 98.1% of surgeries compared to 1 case with a spinous process clamp. Intraoperative 3D imaging scans (Scan & Plan) were used for 69.2% of the robotic registrations to the patient and intraoperative fluoroscopy-CT scans were used for 30.8%. 644 total screws were placed, with 427 placed robotically. Specifically, in the sacral-pelvic region, 98 S1, 18 S2, 58 S2AI, and 5 iliac screws were placed using RAN (179 screws). In 17 cases with 139 total robotic screws, post-instrumentation intraoperative 3D imaging or postoperative CT scans were obtained. Of these screws, 99.3% (138/139; 95% CI = 95.5-99.96) were placed accurately (Grade A or Grade B). One S2AI screw had an anterior breach on intraoperative 3D imaging scan and was changed prior to closure. Loss of RAN registration was observed in 2 cases (3.8%). No cases required return to the operating room for screw malposition. CONCLUSION This study highlights high screw accuracy with no neurologic compromise associated with the use of RAN technology.
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Affiliation(s)
- Craig Birch
- Department of Orthopedic Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Nicole Welch
- Department of Orthopedic Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Danielle Cook
- Department of Orthopedic Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Daniel Hedequist
- Department of Orthopedic Surgery, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
- Harvard Medical School, Boston, MA, USA
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Ouchida J, Nakashima H, Ohara T, Machino M, Ito S, Segi N, Yamauchi I, Imagama S. Patterns of sitting spinal alignment in non-ambulatory scoliosis patients with paraplegia: an observational study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2025; 34:556-564. [PMID: 39611971 DOI: 10.1007/s00586-024-08584-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 10/17/2024] [Accepted: 11/22/2024] [Indexed: 11/30/2024]
Abstract
PURPOSE To classify sagittal spinopelvic alignment patterns of non-ambulatory scoliosis patients with paraplegia based on lateral sitting radiographs and explore their relation to clinical background and physical function. METHODS We reviewed non-ambulatory scoliosis patients with paraplegia, excluding those with prior spinal surgery from a single-center database. Alignment patterns in sitting postures were classified into slump sitting (SS) and erect sitting (ES) based on the most posterior edge of the spine's location on lateral sitting radiographs. Radiographical spinopelvic sagittal alignment, demographics, and physical functions were analyzed. Clinical scoring for physical functions included Hoffer's ambulator classification, Hoffer's modified sitting classification, and the Modified Ashworth Score (MAS) for the severity of spasticity in the lower extremities. Percentages of patients without spasticity, with MAS of 0 indicating "no spasticity." were also compared between the two alignment patterns. RESULTS Of 172 patients screened, 86 met inclusion criteria, revealing two distinct alignment patterns: SS showed greater thoracic kyphosis, smaller lumbar lordosis, pelvic retroversion, and hip hyperflexion compared to ES. No significant differences in demographic data or curve patterns were observed between groups. The SS group had a significantly higher percentage of patients without spasticity compared to the ES group (39.2% vs. 14.3%, P = 0.016). CONCLUSION Identified were two distinct sagittal alignment patterns in seated scoliosis patients with paraplegia, with potential influences from spasticity in the lower extremities. Recognizing these patterns can aid in assessing the function of sitting balance that includes the hip joint and in optimizing strategies for the treatment of scoliosis patients with paraplegia.
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Affiliation(s)
- Jun Ouchida
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya-shi, Aichi, 466-8550, Japan
| | - Hiroaki Nakashima
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya-shi, Aichi, 466-8550, Japan.
| | - Tetsuya Ohara
- Department of Orthopedics and Spine Surgery, Meijo Hospital, Nagoya, Japan
| | - Masaaki Machino
- Department of Orthopedics and Spine Surgery, Meijo Hospital, Nagoya, Japan
| | - Sadayuki Ito
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya-shi, Aichi, 466-8550, Japan
| | - Naoki Segi
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya-shi, Aichi, 466-8550, Japan
| | - Ippei Yamauchi
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya-shi, Aichi, 466-8550, Japan
| | - Shiro Imagama
- Department of Orthopaedics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya-shi, Aichi, 466-8550, Japan
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Zhang HQ, Deng A, Guo CF, Sun Y, Li MJ. Multi-rod posterior correction only with halo-femoral traction for the management of adult neuromuscular scoliosis (> 100°) with severe pelvic obliquity: a minimum 5-year follow-up. J Orthop Surg Res 2023; 18:786. [PMID: 37858229 PMCID: PMC10585782 DOI: 10.1186/s13018-023-04285-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 10/14/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Many patients with neuromuscular scoliosis (NMS) experience a variety of difficult medical problems that aggravate the development effects of progressive scoliosis and pelvic obliquity (PO). The objective of the current study was to assess the safety and effectiveness of multi-rod posterior correction only (MRPCO) with halo-femoral traction (HFT) for the management of adult NMS (> 100°) with severe PO. METHODS From 2012 to 2017, 13 adult patients who suffered from NMS (> 100°) with severe PO underwent MRPCO with HFT. The radiography parameters in a sitting position, such as the coronal Cobb angle of the main curve, the PO and the trunk shift (TS), were measured at the preoperative, postoperative and final follow-up stages. The preoperative and final follow-up assessment of the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI) was taken. RESULTS The average follow-up span was 68.15 ± 6.78 months. There was decreased postoperative coronal Cobb angle with an average mean of 125.24° ± 11.78° to 47.55° ± 12.10°, with a correction rate of 62.43%; the PO was reduced to 6.25° ± 1.63° from 36.93° ± 4.25° with a correction rate of 83.07%; the TS was reduced to 2.41 cm ± 1.40 cm from 9.19 cm ± 3.07 cm. There was significant improvement in all parameters compared to the preoperative data. The VAS score reduced from 4.77 ± 0.93 to 0.69 ± 0.75, and the ODI score reduced from 65.38 ± 16.80 to 28.62 ± 12.29 at the final follow-up. CONCLUSIONS Treatment of adult NMS (> 100°) with severe PO could be safe and effective with MRPCO with HFT. In order to obtain the optimum sitting balance, this could reduce the prevalence of complications and rectify the curvature and the correction of PO.
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Affiliation(s)
- Hong-Qi Zhang
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, China
| | - Ang Deng
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, China.
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, China.
| | - Chao-Feng Guo
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, China
| | - Yang Sun
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, China
| | - Meng-Jun Li
- Department of Spine Surgery and Orthopaedics, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Xiangya Road 87, Changsha, China
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Yang JH, Kim HJ, Chang DG, Nam Y, Park GS, Na DG, Suh SW. Clinical and radiological efficacy of spino-pelvic fixation in the treatment of neuromuscular scoliosis. Sci Rep 2023; 13:9993. [PMID: 37340035 DOI: 10.1038/s41598-023-36981-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 06/13/2023] [Indexed: 06/22/2023] Open
Abstract
Pelvic fixation is performed to obtain proper coronal and sagittal alignment when the pelvic obliquity is more than 15º in patients with neuromuscular scoliosis (NMS). Since many NMS patients were wheelchair or bed-ridden status, there has been controversy on the effect of pelvic fixation. Therefore, the purpose of this study is to analyze the effects of pelvic fixation on correction of spinal deformity and quality of life (QoL) in NMS patients. A total of 77 NMS patients who underwent deformity correction were divided into three groups and retrospectively analyzed preoperatively, postoperatively, and at 2-year follow-up: pelvic fixation group (Group A, n = 16), fixed to S1 (Group B, n = 33), and fixed to L5 (Group C, n = 28). The correction rate of scoliosis was 60.0%, 58.0%, and 56.7% in groups A, B, and C, respectively, with no statistical difference (P > 0.05). The correction rate of pelvic obliquity was 61.3%, 42.8%, and 57.5% in respective groups A, B, and C, with no significance (P > 0.05). The correction loss of scoliosis and pelvic obliquity showed no statistical significance between three groups for 2-year follow-up (all Ps > 0.05). There were no significant differences regarding clinical outcomes and postoperative complications among the three groups (all Ps > 0.05). Therefore, pelvic fixation using iliac screws is not substantially influencing radiological and clinical outcomes in the patients with NMS.
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Affiliation(s)
- Jae Hyuk Yang
- Department of Orthopedic Surgery, Korea University Anam Hospital, 73 Goryeodae-ro Seongbuk-gu, Seoul, 02841, Korea
| | - Hong Jin Kim
- Department of Orthopedic Surgery, Spine Center, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, 1342, Dongil-ro, Nowon-gu, Seoul, 01757, Korea
| | - Dong-Gune Chang
- Department of Orthopedic Surgery, Spine Center, Inje University Sanggye Paik Hospital, College of Medicine, Inje University, 1342, Dongil-ro, Nowon-gu, Seoul, 01757, Korea.
| | - Yunjin Nam
- Department of Orthopedic Surgery, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Korea
| | - Gi Seul Park
- Department of Orthopedic Surgery, Korea University Anam Hospital, 73 Goryeodae-ro Seongbuk-gu, Seoul, 02841, Korea
| | - Dong Gyoon Na
- Geelong Clinical School, School of Medicine, Faculty of Health, Deakin University, Little Malop St, Geelong, VIC, 3220, Australia
| | - Seung Woo Suh
- Department of Orthopedic Surgery, Korea University Guro Hospital, 148, Gurodong-ro, Guro-gu, Seoul, 08308, Korea
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Yen W, Gartenberg A, Cho W. Pelvic obliquity associated with neuromuscular scoliosis in cerebral palsy: cause and treatment. Spine Deform 2021; 9:1259-1265. [PMID: 33861427 DOI: 10.1007/s43390-021-00346-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 04/05/2021] [Indexed: 10/21/2022]
Abstract
STUDY DESIGN Literature Review. OBJECTIVE Review the etiology, clinical manifestations, diagnosis, and treatment of pelvic obliquity in cerebral palsy patients with neuromuscular scoliosis. Neuromuscular scoliosis (NMS) in cerebral palsy (CP) patients is rapidly progressive and often leads to an imbalance in musculoskeletal mechanics that extends to the pelvis. A horizontal misalignment of the pelvis in the frontal plane known as pelvic obliquity (PO) is a common finding in this population. When untreated, PO can exacerbate the back pain, postural strain, and walking difficulties experienced by these patients. Establishing the manifestation and treatment plan for PO in the setting of NMS can provide valuable insight for diagnosis and management. METHODS A comprehensive literature review was performed on the etiology, clinical manifestations, diagnosis, and treatment of pelvic obliquity in the setting of NMS in CP. The advantages and limitations of measurement and treatment options were evaluated. RESULTS PO is categorized into suprapelvic, infrapelvic, and intrapelvic causes, each presenting with a unique pattern of pathology. NMS in CP with hip contractures and structural deformities fall into these categories. The Maloney and O'Brien methods of pelvic measurement have demonstrated superior utility and are recommended for clinical diagnosis. The management of PO in NMS patients is focused on the cause of malalignment, with posterior fusion, contracture release, and osteotomy encompassing the mainstay of treatment. CONCLUSION PO is commonly found in patients with NMS in cerebral palsy. There is currently no standard method for determining the PO angle. Interventions designed to reduce scoliotic curves and release tissue contractures can level the pelvis and restore proper alignment of the spine and sacrum in the coronal plane in these patients. Further understanding of the causes of PO in NMS, as well as the establishment of a standardized measuring technique and diagnostic parameters will allow for more effective treatment options and improve outcomes in patients with CP. LEVEL OF EVIDENCE N/A.
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Affiliation(s)
- Winston Yen
- Touro College of Osteopathic Medicine, Middletown, NY, USA
| | - Ariella Gartenberg
- Department of Orthopedic Surgery, Albert Einstein College of Medicine/Montefiore Medical Center, 3400 Bainbridge Ave, 6th Floor, Bronx, NY, 10461, USA
| | - Woojin Cho
- Department of Orthopedic Surgery, Albert Einstein College of Medicine/Montefiore Medical Center, 3400 Bainbridge Ave, 6th Floor, Bronx, NY, 10461, USA.
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Monro P, Knight D, Pringle W, Fyfe D, Shearer J. The Use of the Chorioallantoic Membrane (CAM) of the Embryonic Chick for the Direct Assessment of Implant Toxicity. Altern Lab Anim 2020. [DOI: 10.1177/026119298501300403] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The toxicity of implant materials requires investigation prior to clinical use. We have developed a method where materials are directly applied to the chorioallantoic membrane (CAM) of 9-day-old chick embryos and toxicity is assessed using histological criteria. We evaluated the method using metal foils. The number and organisation of fibroblasts seemed to be the most useful criteria for assessing metal toxicity. Differences were greatest after 10 days of culture on the CAM. The method is sensitive enough to enable us to discriminate between the less toxic aluminium and titanium and the highly toxic cobalt, nickel and tungsten. The proposed method has advantages over in vitro techniques which provide an abnormal fluid environment and in which the more complex interactions that are possible between implant materials and tissue in vivo cannot be modelled.
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Affiliation(s)
- P.P. Monro
- Academic Orthopaedic Unit, Southampton General Hospital, Tremona Road, Southampton SO9 4XY, UK
| | - D.P. Knight
- Department of Biological Sciences, King Alfred College, Winchester SO22 4NR, UK and
| | - W.S. Pringle
- Academic Orthopaedic Unit, Southampton General Hospital, Tremona Road, Southampton SO9 4XY, UK
| | - D.M. Fyfe
- Department of Basic Dental Sciences, The Dental School, Manchester M15 6FH, UK
| | - J.R. Shearer
- Academic Orthopaedic Unit, Southampton General Hospital, Tremona Road, Southampton SO9 4XY, UK
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Anari JB, Cahill PJ, Flynn JM, Spiegel DA, Baldwin KD. Intra-operative computed tomography guided navigation for pediatric pelvic instrumentation: A technique guide. World J Orthop 2018; 9:185-189. [PMID: 30364843 PMCID: PMC6198293 DOI: 10.5312/wjo.v9.i10.185] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 07/29/2018] [Accepted: 08/05/2018] [Indexed: 02/06/2023] Open
Abstract
Pelvic instrumentation for neuromuscular scoliosis has been part of neuromuscular scoliosis surgery since the era of the Luque Galveston construct. Unit Rod (Medtronic Sofamor-Danek, Nashville, TN) instrumentation brought with it the concept of cantilever correction by placing the implants in the pelvis and then gradually bringing the rod to the spine by sequentially tightening the sublaminar wires, with the goal of creating a level pelvis over a straight spine. More recently surgeons have utilized pedicle screw constructs in which the corrective strategies have varied. Challenges with pelvic fixation using iliac screws linked to the spinal rod have led to the development of the S2-alar-iliac technique (S2AI) in which the spinal rod connects to the pelvic screw. The screw is placed in the S2 ala, crosses the sacro-iliac joint and into the ilium through a large column of supra-acetabular bone. This column is the same area used for anterior inferior iliac spine external fixation frames used in trauma surgery. S2AI screw placement can be technically difficult and can require experienced radiology technologists to provide the appropriate views. Additionally, although the technique was originally described being placed via freehand technique with intra-operative flouroscopy, the freehand technique suffers from the anatomic anomalies present in the pelvis in neuromuscular scoliosis. As such, we prefer to place them using intra-operative navigation for all pediatric spinal deformity cases. Below in detail we report our intra-operative technique and an illustrative case example.
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Affiliation(s)
- Jason B Anari
- Department of Orthopaedic Surgery, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, United States
| | - Patrick J Cahill
- Department of Orthopaedic Surgery, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, United States
| | - John M Flynn
- Department of Orthopaedic Surgery, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, United States
| | - David A Spiegel
- Department of Orthopaedic Surgery, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, United States
| | - Keith D Baldwin
- Department of Orthopaedic Surgery, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, United States
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Patel J, Shapiro F. Simultaneous progression patterns of scoliosis, pelvic obliquity, and hip subluxation/dislocation in non-ambulatory neuromuscular patients: an approach to deformity documentation. J Child Orthop 2015; 9:345-56. [PMID: 26423268 PMCID: PMC4619374 DOI: 10.1007/s11832-015-0683-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 09/04/2015] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND A triad of deformities-thoracolumbar scoliosis, pelvic obliquity, and femoral head (hip) subluxation/dislocation-occurs frequently in non-ambulatory neuromuscular patients, but their close inter-relationship is infrequently appreciated or quantified. We propose a deformity documentation approach to assess each component simultaneously. METHODS The documentation assesses each component for maximal functional level, deformity, and flexibility/rigidity: deformity from antero-posterior radiographs (scoliosis-maximal functional position, pelvic obliquity-sitting, hip position-supine) and flexibility/rigidity from extent of repositioning on supine (spine, pelvis) and frog lateral (hip) radiographs. The approach was applied in 211 patients: Duchenne muscular dystrophy (110), spinal muscular atrophy (49), cerebral palsy (26), and other neuromuscular disorders (26). RESULTS Measurement of 2124 radiological data points allowed for deformity (mild to moderate to severe) and flexibility/rigidity (fully reducible to partially to non-reducible) gradations for scoliosis, pelvic obliquity, and hip subluxation/dislocation. The charting documented: (1) numerical deformity and flexibility/rigidity changes [x-axis: age; y-axis: angulation (scoliosis and pelvic obliquity) and percent coverage (hip subluxation or dislocation) from 0-120]; and (2) grade deformity and flexibility/rigidity changes [x-axis: age; y-axis: deformity and flexibility/rigidity, following conversion of numerical measurements to a 1-5 grade scale]. In subgroups with the most extensive documentation, thoracolumbar and lumbar scoliosis extended into the sacrum with 98 % (114/116) accompanied by pelvic obliquity; and scoliosis developed more rapidly than hip deformity in 44 % (28/63), scoliosis and hip deformity developed at the same time in 40 % (25/63), and hip deformity developed more rapidly than scoliosis in 16 % (10/63) (Pearson's chi-squared test p = 0.0501, almost significant). CONCLUSION AND SIGNIFICANCE Documentation of the triad of neuromuscular deformities is applicable to all diagnoses; it outlines maximal functional level, deformity, and flexibility/rigidity at each site; and it shows the relationship between spine, pelvic, and hip deformation. Prospective charting will enhance both clinical management and clinical research into neuromuscular deformity.
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Zhou X, Wang Q, Zhang X, Chen Y, Shen H, Jiang Y. Effect of pelvic obliquity on the orientation of the acetabular component in total hip arthroplasty. J Arthroplasty 2012; 27:299-304. [PMID: 22054902 DOI: 10.1016/j.arth.2011.09.022] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Accepted: 09/22/2011] [Indexed: 02/01/2023] Open
Abstract
In infrapelvic obliquity, coronal pelvic malrotation entails a change in the spatial location of the bony acetabulum. In the present study, 77 patients presented with infrapelvic obliquity with types 1 and 2 hip pathologies in which the pelvis is lower and higher, respectively, on the short-leg side. The 2 types were classified into 3 subtypes (A, B, and C) according to the severity of the pelvic obliquity (0°-3°, 3°-6°, and >6°). Angles of inclination of pelvic obliquity postoperatively, anteversions, and inclinations (abduction angle) for acetabular components were measured after total hip arthroplasty. Increased inclination (mean, 8.79°) was observed in type 1C, where the angle of inclination to pelvic obliquity postoperatively was minimally corrected. This increase may lead to cup instability. Rebalancing the pelvis in these cases with preoperative skeletal traction and/or sufficient release of hip contractures may be necessary. A correction of the mean inclination of the cup by 8.79° is required.
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Affiliation(s)
- Xiaoxiao Zhou
- Department of Orthopedics, Taizhou Central Hospital, Taizhou, Zhejiang Province, People's Republic of China
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Pelvic obliquity in neuromuscular scoliosis: radiologic comparative results of single-stage posterior versus two-stage anterior and posterior approach. Spine (Phila Pa 1976) 2011; 36:146-52. [PMID: 20634783 DOI: 10.1097/brs.0b013e3181cd2a55] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN retrospective comparative study (Level III). OBJECTIVE to compare the operative results of posterior fusion and a 2-stage anterior L5-S1 fusion followed by posterior fusion in neuromuscular scoliosis patients with significant pelvic obliquity (PO). SUMMARY OF BACKGROUND DATA PO in neuromuscular scoliosis is common and a challenging problem that affects proper sitting balance, necessarily addressing the deformity and proper maintenance of the correction. METHODS a total of 54 patients with neuromuscular scoliosis and significant PO (>10°) were divided into 2 groups. Group 1 (n = 24) was operated on for posterior fusion and pelvic fixation. Group 2 (n = 30) included patients who were subjected to a first-stage procedure consisting of a lumbosacral junction release and fusion through a midline retroperitoneal approach and then a second-stage procedure of posterior fusion and pelvic fixation. Parameters measured included length of the follow-up, number of fusion levels, age at operation, forced vital capacity, operative time, estimated blood loss, and postoperative complications. Radiologic parameters measured before surgery, after surgery at the time of discharge, and at a final follow-up included Cobb angle, T1 translation, sitting pelvic obliquity (PO) in the frontal plane, C7 plumb line, thoracic kyphosis, lumbar lordosis, and sacral inclination angle in the sagittal plane. RESULTS the correction of scoliosis was similar in both groups. The preoperative PO averaged 19.5° in Group I and 22.9° in Group II (P = 0.22), which corrected after surgery to 9.7° versus 7.4° (P = 0.23), respectively. Group II correction progressively improved significantly compared to Group I (7.0° vs. 11.6° at P = 0.046) at the latest follow-up. A 40.6% correction (mean correction = 7.9) in sitting PO in Group I compared to 70.7% correction (mean correction = 5.9°) in Group II was observed (P = 0.004). The average loss of correction of PO at the final follow-up was lesser in group II, but not statistically significant (P = 0.07). CONCLUSION anterior fusion of the lumbosacral junction followed by posterior fusion provides superior correction and maintenance of PO in patients with neuromuscular scoliosis.
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Marafi FA, Al-Said Ali A, Esmail AA, Elgazzar AH. Baseline patterns of bone scintigraphy in patients with established post-poliomyelitis paralysis. Skeletal Radiol 2010; 39:891-5. [PMID: 19593558 DOI: 10.1007/s00256-009-0739-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2009] [Revised: 05/21/2009] [Accepted: 06/07/2009] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Post-poliomyelitis syndrome causes variable musculoskeletal manifestations including pain, muscle weakness and fatigue. These manifestations are commonly secondary to overuse and misuse of muscles and joints and could follow a fall. Bone scan can be useful in determining the underlying cause and follow-up. The objective of this study was to describe the late scintigraphic patterns on bone scan following poliomyelitis. MATERIALS AND METHODS Bone scans of 8 adult patients (7 female and 1 male), aged 35 to 53 years, who were known to have paralytic poliomyelitis, were retrospectively studied. Six patients had unilateral while 1 had bilateral disease. All patients had three-phase bone scan and 5 had SPECT study as well. Studies were reviewed by two qualified nuclear medicine physicians and findings were recorded and analyzed. RESULTS Several patterns were consistently identified: decreased blood pool activity in the affected lower limb of all patients; deformed ipsilateral hemi-pelvis with reduced uptake on the affected side in all patients with unilateral disease; stress changes with increased uptake in the bones of the contra-lateral lower extremity; and degenerative changes in multiple joints (shoulder, knee, hip, ankle and spine). Significant scoliosis was only noted in the patient with bilateral disease. CONCLUSION Scintigraphic patterns on bone scan associated with the post-poliomyelitis syndrome and persistent weakness following a distant episode of poliomyelitis have been described. Awareness of these characteristic scintigraphic findings may facilitate an accurate diagnosis and lead to more appropriate patient management.
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Affiliation(s)
- Fahad A Marafi
- Departments of Nuclear Medicine, Mubarak Alkabeer Hospital and Kuwait University, Safat, Kuwait
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Intrasacral rod fixation for pediatric long spinal fusion: results of a prospective study with a minimum 5-year follow-up. J Pediatr Orthop 2009; 29:594-601. [PMID: 19700989 DOI: 10.1097/bpo.0b013e3181b2b403] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Lumbosacral fusion is often needed in cases of pediatric neuromuscular spinal deformities. Despite the numerous fixation techniques described, the procedure remains challenging. Jackson has described a method of intrasacral fixation providing immediate 3-dimensional stability and promising clinical results. The purpose of this study was to report our experience with long spinal fusion using Jackson intrasacral fixation in pediatric patients. METHODS All patients with at least 5 years of follow-up were reviewed. No brace was used postoperatively. Clinical data and radiographs were collected and analyzed preoperatively, postoperatively, and at latest follow-up. Intraoperative and postoperative complications were reported. Paired t test was used for statistical analysis. RESULTS Fifty-six patients were included. The average age at surgery was 15.3 years. Mean follow-up period was 10.3 years and no patient was lost to follow-up. All radiographic parameters (frontal balance, frontal Cobb angle of the primary curve, iliolumbar angle, pelvic obliquity, sagittal balance, lumbosacral lordosis, and sacral slope) were significantly improved postoperatively (P<0.001), without significant loss of correction at latest follow-up. Four early infections, 1 pressure sore, and 4 cases of radicular pain, which resolved without intervention, were reported postoperatively. At latest follow-up, no patient complained of lumbar pain, and neither ambulatory status nor activity level ability worsened in any case. Sixteen of the 20 patients who needed a sitting orthosis preoperatively achieved a functional sitting posture without bracing. CONCLUSIONS Jackson fixation is a safe and reliable technique providing immediate stability. In our series, no mechanical complication occurred and no loss of correction was observed, despite immediate unprotected mobilization. The method provides reliable good sacral fixation for pediatric neuromuscular spinal deformities, especially when the correction of severe pelvic obliquity is necessary. LEVEL OF EVIDENCE This consecutive series provides level IV evidence.
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Boulay C, Tardieu C, Bénaim C, Hecquet J, Marty C, Prat-Pradal D, Legaye J, Duval-Beaupère G, Pélissier J. Three-dimensional study of pelvic asymmetry on anatomical specimens and its clinical perspectives. J Anat 2006; 208:21-33. [PMID: 16420376 PMCID: PMC2100175 DOI: 10.1111/j.1469-7580.2006.00513.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The aim of this study was to assess pelvic asymmetry (i.e. to determine whether the right iliac bone and the right part of the sacrum are mirror images of the left), both quantitatively and qualitatively, using three-dimensional measurements. Pelvic symmetry was described osteologically using a common reference coordinate system for a large sample of pelvises. Landmarks were established on 12 anatomical specimens with an electromagnetic Fastrak system. Seventy-one paired variables were tested with a paired t-test and a non-parametric test (Wilcoxon). A Pearson correlation matrix between the right and left values of the same variable was applied exclusively to values that were significantly asymmetric in order to calculate a dimensionless asymmetry index, ABGi, for each variable. Fifteen variables were significantly asymmetric and correlated with the right vs. left sides for the following anatomical regions: sacrum, iliac blades, iliac width, acetabulum and the superior lunate surface of the acetabulum. ABGi values above a threshold of +/- 4.8% were considered significantly asymmetric in seven variables of the pelvic area. Total asymmetry involving the right and the left pelvis seems to follow a spiral path in the pelvis; in the upper part, the iliac blades rotate clockwise, and in the lower part, the pubic symphysis rotates anticlockwise. Thus, pelvic asymmetry may be evaluated in clinical examinations by measuring iliac crest orientation.
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Affiliation(s)
- Christophe Boulay
- Département de Médecine Physique et de Réadaptation, CHU Caremeau, Nîmes, France.
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Abstract
STUDY DESIGN Outcomes are retrospectively compared for patients with neuromuscular scoliosis after instrumented surgery and fusion to the pelvis versus lumbar 5 fusion alone. OBJECTIVES To compare outcomes for patients with neuromuscular scoliosis for correction of scoliosis, lumbar 5 tilt, and pelvic obliquity after instrumented surgery and pelvic fusion, and by fusion only to lumbar 5. SUMMARY OF BACKGROUND DATA Correction of scoliosis and pelvic obliquity in neuromuscular disease using spinal instrumentation is an accepted surgical procedure. Controversy remains concerning the caudal extent of fusion and instrumentation to lumbar 5 or to the sacrum. METHODS Patients with progressive neuromuscular scoliosis underwent spinal fusion with segmental instrumentation using a U-rod terminating in pedicle screw fixation at L5. Similar patients underwent spinal fusion with a unit rod and sacral fusion. RESULTS From 1998 to 2002, 55 patients with neuromuscular scoliosis underwent instrumentation and L5 fusion with the U-rod or to the sacrum with the unit rod. Initial and long-term corrections of scoliosis and pelvic obliquity were similar in both groups. CONCLUSIONS Instrumentation and fusion to L5 is a less technically difficult procedure, requires less surgical time, has decreased blood loss, and less risk of infection compared to instrumented pelvic fusion. Postoperative and long-term follow-up indicates that L5 fusion can correct scoliosis and pelvic obliquity, comparable to results of sacrum fusion.
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Thacker M, Hui JHP, Wong HK, Chatterjee A, Lee EH. Spinal fusion and instrumentation for paediatric neuromuscular scoliosis: retrospective review. J Orthop Surg (Hong Kong) 2002; 10:144-51. [PMID: 12493926 DOI: 10.1177/230949900201000207] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
PURPOSE A retrospective study was conducted to review the surgical results among 24 patients with neuromuscular scoliosis, who were treated with spinal instrumentation and fusion at the Department of Orthopaedic Surgery, National University Hospital, Singapore between March 1993 and December 1998. METHODS We examined complete hospital records of patients who had scoliosis due to aetiologies such as spinal muscular atrophy, cerebral palsy, Duchenne muscular dystrophy, and congenital myopathies. The mean age of patients was 10.6 years (range, 6-14 years) and the mean follow-up duration was 5.5 years. RESULTS 18 patients had posterior surgery alone, whereas 4 had an anterior release with posterior instrumentation, and 2 had an anterior fusion with instrumentation. The mean length of stay in the intensive care unit was 2 days and the mean duration of hospital stay was 11 days. The mean correction in scoliosis angle ranged from 75.6 degrees to 25.7 degrees. All patients could at least sit without support postoperatively. The one-second forced expiratory volume and forced vital capacity were, in general, maintained throughout the follow-up. There were 2 major complications and 2 minor ones; these were pseudarthrosis with rod breakage requiring revision, deep infection necessitating hardware removal, superficial infection that responded to antibiotics, and urinary tract infection requiring 3 weeks of antibiotic treatment. There were no deaths or any neurological complications after instrumentation. CONCLUSION Spinal stabilisation and fusion in children with neuromuscular scoliosis is a safe and effective treatment modality. The effect of surgery on long-term pulmonary function, however, remains controversial and needs to be addressed.
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Affiliation(s)
- M Thacker
- Department of Orthopaedic Surgery, National University Hospital, National University of Singapore, 5 Lower Kent Ridge Road, Singapore
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Wild A, Haak H, Kumar M, Krauspe R. Is sacral instrumentation mandatory to address pelvic obliquity in neuromuscular thoracolumbar scoliosis due to myelomeningocele? Spine (Phila Pa 1976) 2001; 26:E325-9. [PMID: 11462098 DOI: 10.1097/00007632-200107150-00019] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective study. OBJECTIVE To evaluate the functional outcome of two-stage anterior and posterior instrumented fusion without fixation to the sacrum on 11 patients with neuromuscular scoliosis from thoracolumbar myelomeningocele. SUMMARY OF BACKGROUND DATA To our knowledge, there are no published results of combined anterior and posterior correction and fusion without inclusion of the sacrum in neuromuscular scoliosis from thoracolumbar myelomeningocele. In this article we present our experience and critically evaluate the functional outcome on 11 patients with neuromuscular scoliosis. PATIENTS AND METHODS From July 1, 1992 through June 30, 1995, 11 consecutive patients with severe thoracolumbar scoliosis were admitted at our hospital. The mean age at operation was 12 years 9 months (range 9 years 9 months to 14 years 6 months). All patients underwent a two-stage anterior and posterior spinal reconstruction. The patients were evaluated before surgery and after surgery. RESULTS All patients were observed for a mean of 4 years 11 months (range 42-88 months) from the time of second stage procedure. Before treatment the mean scoliosis was 81 degrees (range 55-110 degrees ); this was reduced to a mean of 31 degrees (range 8-70 degrees ), and at the final follow-up the correction had deteriorated slightly to a mean of 35 degrees (range 12-80 degrees ). No patient had increased neurologic deficit or showed other major complication. CONCLUSIONS Pelvic obliquity in thoracolumbar neuromuscular scoliosis from lumbosacral myelomeningocele spontaneously corrected when the scoliotic deformity is adequately addressed with instrumented fusion without inclusion of the sacrum. The correction obtained remained stable at follow-up. In the absence of a control group we believe that sparing lumbar segments from primary fusion offers these patients a better freedom of mobility.
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Affiliation(s)
- A Wild
- Centre for Spinal Studies and Surgery, University Hospital, Nottingham, UK.
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King AG, Thomas KA, Eiserloh HL, Mills TE, Pisciotta DN. Analysis of the STIF technique for spino-pelvic fixation: clinical results in 19 patients with neuromuscular scoliosis. J Pediatr Orthop 2000; 20:667-76. [PMID: 11008751 DOI: 10.1097/00004694-200009000-00023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The STIF (spinopelvic transiliac fixation) technique for lumbosacral fusion was developed by the authors as an alternative to the Luque-Galveston technique. The results observed in this initial series of 27 neuromuscular scoliosis patients treated with the STIF technique are reported. With a minimum of 24 months of radiographic follow-up in 19 patients, the percentage of correction of scoliosis curvature and pelvic obliquity was superior to that reported in the literature. The rates of complications and pseudarthrosis in this series are typical for this patient population. The STIF technique facilitates compression across the sacroiliac joints, which promotes sacroiliac joint fusion and can provide a stable base for curvature correction and lumbosacral fusion. Despite the severe coronal and sagittal plane curves in this group of patients, total operative time also compares favorably to that reported in the literature. The STIF technique requires a well-developed posterior iliac apophysis, which may not be present in younger pediatric patients.
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Affiliation(s)
- A G King
- Department of Orthopaedic Surgery, Louisiana State University Health Sciences Center, New Orleans 70112-2289, USA
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Hartford JM, McCullen GM, Harris R, Brown CC. The iliolumbar ligament: three-dimensional volume imaging and computer reformatting by magnetic resonance: a technical note. Spine (Phila Pa 1976) 2000; 25:1098-103. [PMID: 10788854 DOI: 10.1097/00007632-200005010-00010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN An assessment of magnetic resonance imaging techniques of the iliolumbar ligament. OBJECTIVES To identify a technique to better image the iliolumbar ligament. SUMMARY OF BACKGROUND DATA The iliolumbar ligament plays an important role in providing lumbosacral stability. Two-dimensional magnetic resonance imaging of the lumbar spine only provides a fragmented representation of the ligament. METHODS A two-part study was performed. In the first part, three cadaver pelvi were dissected, and the individual bands of the iliolumbar ligament were identified. Computer reformatting of magnetic resonance three-dimensional volume images then were performed, correlating the structural characteristics of the iliolumbar ligament to its magnetic resonance image. In the second part of the study, the lumbosacral region of three groups of patients were evaluated. Group I was studied with routine magnetic resonance imaging techniques of the intervertebral disc regions. Group II was studied with routine contiguous axial magnetic resonance imaging of the lumbosacral spine. Group III was studied with computer reformatting of three-dimensional volume images of the lumbosacral spine. RESULTS Accurate imaging of the iliolumbar ligament of cadaver specimens was achieved with three-dimensional volume imaging and computer reformatting. Routine imaging of the intervertebral disc region as well as contiguous axial imaging of the spine depicted only limited segments of the iliolumbar ligament. Three-dimensional volume imaging and computer reformatting allowed precise imaging of the iliolumbar ligament in all patients, demonstrating the ligament orientation as well as length, width, and depth. CONCLUSION Only images of the iliolumbar ligament obtained through computer reformatting of three-dimensional volume averaging from L3 to the sacral ala correlated with the ligament's structural characteristics.
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Affiliation(s)
- J M Hartford
- Division of Orthopaedic Surgery, University of Kentucky Medical Center, Lexington, Kentucky 40536-0284, USA.
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Widmann RF, Hresko MT, Hall JE. Lumbosacral fusion in children and adolescents using the modified sacral bar technique. Clin Orthop Relat Res 1999:85-91. [PMID: 10416396 DOI: 10.1097/00003086-199907000-00012] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Between 1986 and 1995 10 patients who were 9 to 18 years of age underwent posterior spinal fusion and instrumentation to the pelvis for correction of spinal deformity using the modified sacral bar technique at the authors' institution. Etiologies of the spinal deformity included congenital scoliosis, cerebral palsy, myelomeningocele, neurofibromatosis, and postlaminectomy kyphosis. Indications for pelvic instrumentation were progressive scoliosis of the lower lumbar spine, pelvic obliquity greater than 15 degrees, and dysraphic posterior elements. Five of the patients had prior spinal surgery. Five patients had a prior or a planned pelvic osteotomy. Nine of the patients achieved lumbosacral fusion without an additional procedure. Major complications included loss of pelvic fixation in two patients, and a dural leak and a wound infection in another patient with myelomeningocele. Mean scoliotic curve correction was from 71.9 degrees to 34.5 degrees at final followup. Lumbar lordosis essentially was unchanged. Pelvic obliquity was corrected from a mean of 20.5 degrees preoperatively to a mean of 7.6 degrees at final followup. The modified sacral bar technique was selected for fusion to the sacrum because of planned or prior pelvic osteotomies, prior posterior spinal fusion and instrumentation, sacral dysraphism, or local anatomic anomalies. The modified sacral bar technique proved to be an effective technique in these patients.
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Affiliation(s)
- R F Widmann
- Department of Orthopaedic Surgery, Hospital for Special Surgery, Cornell University Medical College, New York, NY 10021, USA
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Abstract
Neuromuscular scoliosis is classified as a neuropathic or myopathic type. Cerebral palsy is the most common form of neuropathic type, and Duchenne's muscular dystrophy best characterizes the principles and recommended treatment for the myopathic type. Nonoperative measures rarely fully control a progressive scoliosis. Careful preoperative planning and surgery can achieve a well-balanced spine over a level pelvis with a good functional result.
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Affiliation(s)
- R E McCarthy
- Arkansas Spine Center, Departments of Orthopaedics and Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas 72205, USA
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Frischhut B, Sterzinger W, Rachbauer F, Klestil T, Krismer M, Bauer R. Surgical treatment of neuropathic scoliosis: morphologic and functional outcome. Arch Orthop Trauma Surg 1997; 116:367-72. [PMID: 9266043 DOI: 10.1007/bf00433992] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We evaluated the morphologic and functional outcome as well as the extent of satisfaction following surgical treatment in 41 patients with progressive neuropathic scoliosis. The mean follow-up time was 5.6 years (range 2.5-20 years), and follow-up rate was 97.6%. Posterior spine fusion was performed with new instrumentation techniques (Luque/Luque-Galveston, CD, ISOLA) in 29 patients, with extension onto the sacrum in 16 patients, and Harrington instrumentation in 12. In 20 patients we did an additional intervertebral disc excision and fusion. Mean correction of the thoracic spine deformity, as assessed by comparing the Cobb angles on pre- and postoperative X-rays, was 53%, and of the lumbar spine 55.2%, in patients classified as Lonstein I. Scolioses classified as Lonstein II evidenced an average correction of 46.2%. Functional improvement according to the Rancho-Los Amigos scheme could be demonstrated in 20 patients. Seventeen patients remained unchanged, whereas 4 patients showed deterioration. Cosmetic results were rated as excellent by 25 patients, good by 7, and poor by 1. For 8 patients the appearance was unimportant. Pain relief was experienced in all cases (n = 4) of the preoperative low-back or abdominal pain. The major complications were deep wound infection in 3 patients which led to revision surgery, and removal of instrumentation in 1 patient.
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Affiliation(s)
- B Frischhut
- University Clinics for Orthopaedics, Innsbruck, Austria
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Sussman MD, Little D, Alley RM, McCoig JA. Posterior instrumentation and fusion of the thoracolumbar spine for treatment of neuromuscular scoliosis. J Pediatr Orthop 1996; 16:304-13. [PMID: 8728629 DOI: 10.1097/00004694-199605000-00004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We reviewed the clinical and technical outcomes of 25 patients with neuromuscular scoliosis, who were treated by Luque instrumentation and posterior spinal fusion from the upper thoracic spine to L5 between 1981 and 1988. A mean curve correction of 46% was obtained operatively with a mean 8 degrees loss of correction during the follow-up period that ranged from 1.9 to 9.4 years (mean, 5.5). Pelvic obliquity was improved 50% from a mean of 16.1 degrees to a mean of 8.1 degrees in 24 patients for whom data were available. At final follow-up, the mean pelvic obliquity increased to 11.4 degrees with only two patients increasing > 8 degrees. The cause for major postoperative increase in pelvic obliquity was continued anterior spinal growth with torsion of the fusion mass and was not related to changes limited to the L5-S1 motion segment. Posterior fusion and instrumentation from the upper thoracic spine to L5 without anterior fusion provides adequate correction and control of spinal deformity for many patients with cerebral palsy. Those patients with significant growth remaining, or with severe deformities, may benefit by preliminary anterior release and fusion or inclusion of the pelvis and sacrum.
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Affiliation(s)
- M D Sussman
- Shriners Hospital for Crippled Children, Portland, Oregon 97201, USA
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O'Brien JP, Holte DC. Simultaneous combined anterior and posterior fusion. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 1992; 1:2-6. [DOI: 10.1007/bf00302134] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Baird RA, DeBenedetti MJ, Eltorai I. Non-septic hip instability in the chronic spinal cord injury patient. PARAPLEGIA 1986; 24:293-300. [PMID: 3774365 DOI: 10.1038/sc.1986.41] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Korovessis P. Operative treatment of neuropathic pelvic obliquity. ARCHIVES OF ORTHOPAEDIC AND TRAUMATIC SURGERY. ARCHIV FUR ORTHOPADISCHE UND UNFALL-CHIRURGIE 1985; 104:307-13. [PMID: 4091637 DOI: 10.1007/bf00435948] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Neuropathic fixed pelvic obliquity remains an important orthopedic problem. The three known methods for operative correction of this deformity are described. The combined VDS and Harrington method is described in this paper, along with its advantages. The combined operation corrects kyphosis, lordosis, and scoliosis and offers immediate stability of the spine with good correction of the fixed pelvic obliquity.
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Abstract
An independent study was undertaken whereby all members of the Scoliosis Research Society as well as orthopedic surgeons known by the authors to be involved in the treatment of spinal deformities were queried to determine 1) the role of various forms of traction, 2) methods and timing ot application, 3) the indications for use with respect to type of spinal deformity and angle of curvature, and 4) the complications encountered during use. Our results indicated a majority of spinal surgeons, 85%, used preoperative traction when curves were greater than 80° . Cotrel's traction was considered ineffective by the majority of respondents. Halofemoral traction was considered to be indicated in rigid curves greater than 80° and/or associated with pelvic obliquity, and paralytic/neuromuscular curves. Halo-pelvic traction has very limited use in "collapsing spines." Halo-gravity techniques (wheelchair, circoelectric bed) have become increasingly popular and their use issate and effective. Halo-cast is widely accepted as an effective method in the treatment of cervical spine fracture/dislocations and cervicothoracic curves.
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Bedbrook GM. Correction of scoliosis due to paraplegia sustained in paediatric age-group [proceedings]. PARAPLEGIA 1977; 15:90-6. [PMID: 896260 DOI: 10.1038/sc.1977.13] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
At the present time our preventive methods do not fully prevent the occurrence of scoliosis subsequent to juvenile paraplegia. The methods of management must be: (a) preventive; (b) early non-operative correction, such as braces; and by (c) operative correction. The operative correction must be both an anterior and posterior procedure to give good spinal alignment. Further follow-up over many years will be necessary to watch these cases, but the initial results are satisfactory re correction. Function has been improved in both (a) respiration and (b) mobility, but at the 'expense' of reduction in some areas of recreation.
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