Multisegmental Lumbar Corporectomy and Transcorporal Fixation for Correction of Extreme Thoracolumbar Kyphosis in Myelomeningocele with Chronic Decubitus

We introduce a novel technique for the treatment of severe kyphosis in myelomeningocele. A 5-year-old paraplegic boy with myelomeningocele presented with severe thoracolumbar kyphosis and a chronic ulcus at the site of the gibbus. The myelomeningocele had been treated during his first week of life, and an accompanying Chiari type II malformation had been treated by ventriculoperitoneal shunting. He subsequently developed a rapidly progressive thoracolumbar kyphosis with an angle of 180 ° between T10 and L5. He also suffered from a chronic superinfected skin ulcus at the site of the gibbus. Since the skin ulcus required plastic surgery reconstruction, we deemed classical posterior fixation after kyphectomy unfeasible. The subsequent operative steps of our novel surgical approach w ere performed in a single-stage surgery. First, a three-level lumbar corporectomy from L1 to L3 was performed. Subsequently, the body of the removed L2 vertebra was isolated and configured as an autologous graft to bridge the gap between the thoracic and the caudal lumbar spine. The graft was fixed via a transcorporal interbody fusion technique with titanium screws, and chopped autologous bone was added for fusion. The skin was closed using rotation flaps. At the 3-year follow-up, the patient and his family reported marked improvement of quality of life, imaging showed solid fusion and the wou nd was unremarkable. Our novel technique with transcorporal fixation provides new perspectives in the tr...
Source: Pediatric Neurosurgery - Category: Neurosurgery Source Type: research

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Conclusions: Five years following “graduation” from growing surgery for early onset scoliosis, there is progression of curve magnitude in both the coronal and sagittal planes up to 2 years, with no further progression at 5 years. A total of 21% of patients undergo at least 1 revision surgery, and average time to revision surgery is over 2 years from last planned surgery. Risk of revision surgery was higher in patients who underwent a spinal fusion as their definitive treatment strategy. Level Evidence: Level III—retrospective comparative. Type of Evidence: Therapeutic.
Source: Journal of Pediatric Orthopaedics - Category: Orthopaedics Tags: Scioliosis/Kyphosis Source Type: research
Background: Early definitive spinal fusion (EF) has been widely recommended to avoid spinal deformity progression for early-onset scoliosis (EOS) with neurofibromatosis type 1 (NF-1). In contrast, growing rod (GR) procedure has recently been recommended for EOS associated with the dystrophic type NF-1. However, no studies have compared the surgical outcomes between EF and GR procedure for EOS with NF-1. The purpose of this study was to compare the surgical outcomes of EF versus GR for early onset and dystrophic scoliosis with NF-1. Methods: This was a retrospective multicenter study; 26 EOS patients with dystrophic ty...
Source: Journal of Pediatric Orthopaedics - Category: Orthopaedics Tags: Scioliosis/Kyphosis Source Type: research
Background: Anterior vertebral body tethering (VBT) is a growth modulating and fusionless treatment option that is considered as a new promising method for the management of adolescent idiopathic scoliosis (AIS). This prospective cohort study aimed to present the minimum 2-year results of anterior VBT applied to 21 skeletally immature patients with AIS. Methods: Twenty-one skeletally immature patients with a diagnosis of AIS were included. A decision to proceed with surgery was established after the detection of curve progression despite the brace (>40 degrees) with a minimum curve flexibility of 30%. Results: P...
Source: Journal of Pediatric Orthopaedics - Category: Orthopaedics Tags: Scioliosis/Kyphosis Source Type: research
Conclusions: TK on intraoperative prone radiographs during PSFI for SK should match the standing TK ∼6 weeks later. Intraoperative prone LL only slightly increases on early standing radiographs. Assuming a routine postoperative course, intraoperative radiographs slightly underestimate TK (by 3 degrees) and LL (by 8 degrees) on>2-year standing radiographs. These parameters (TK, LL, UIV-LIV) are visualized during surgery and should be used in future studies to predict long-term outcomes. Level of Evidence: Level IV—retrospective study.
Source: Journal of Pediatric Orthopaedics - Category: Orthopaedics Tags: Scioliosis/Kyphosis Source Type: research
Conclusions: This study demonstrates that there is minimal error due to image acquisition and measurement when using a biplanar slot scanner. Biplanar slot scanning technology tended to underestimate the size of the marker; however, the least accurate measurements only erred by 1.5% from the true length. This indicates that unlike traditional radiographs the sources of error in biplanar slot scanning images are not due to parallax and are likely due to patient-specific factors and rather than the technology itself.
Source: Journal of Pediatric Orthopaedics - Category: Orthopaedics Tags: Scioliosis/Kyphosis Source Type: research
Study Design. Retrospective study. Objective. The preoperative parameters for predicting the loss of lordosis after cervical laminoplasty were investigated in the present study. Summary of Background Data. Cervical laminoplasty is an effective surgical method to decompress the cervical spinal cord. Maintaining cervical lordosis after laminoplasty is an important factor to ensure the successful surgical treatment. To know the preoperative parameters for predicting loss of lordosis after cervical laminoplasty is important for better outcome after laminoplasty. Methods. In this retrospective study, 106 patients who...
Source: Spine - Category: Orthopaedics Tags: CERVICAL SPINE Source Type: research
Conclusions. Pelvic retroversion and increased translation of L3 from the central sacral line on the early postoperative radiograph were associated with late L3-4 disc wedging in AIS fusions to L3. Careful surgical planning and correction of sagittal alignment are imperative to ensure the long-term outcomes. Level of Evidence: 4
Source: Spine - Category: Orthopaedics Tags: DEFORMITY Source Type: research
Tranexamic acid (TXA) is widely used in surgery for adolescent idiopathic scoliosis (AIS) and has been proved to be efficacious in reducing intraoperative blood loss (IBL) and the transfusion rate. However, the routine TXA regimen was intraoperative administration alone, in which the concentration of TXA could not cover the whole process of hyperfibrinolysis. And, its ability to control the massive postoperative blood loss (PBL) may be insufficient. Thus, we promoted a multiple-dose regimen of TXA for patients with AIS who underwent surgical correction.
Source: The Spine Journal - Category: Orthopaedics Authors: Tags: Clinical Study Source Type: research
Conclusions The studies here suggest that certain pediatric patient populations are at risk for impaired psychosocial functioning as a result of repetitive procedures. However, it is important to differentiate whether the association with poorer psychosocial outcomes is from the number of surgical procedures or whether the number if just a surrogate for increased disease complexity. Standardized psychosocial outcomes measures and future prospective, long-term, randomized clinical trials are also warranted.
Source: Annals of Plastic Surgery - Category: Cosmetic Surgery Tags: Review Papers Source Type: research
CONCLUSIONS: Treatment safety in brace treatment for patients with scoliosis should be improved. One approach may be the use of standardized CAD libraries. Further investigations with study designs of higher evidence are necessary to support the results found in our investigation. PMID: 33025038 [PubMed - as supplied by publisher]
Source: Der Orthopade - Category: Orthopaedics Authors: Tags: Orthopade Source Type: research
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