Hereditary spherocytosis: a risk factor for thigh pressure myonecrosis in posterior spine surgery

The objective of this study was to make surgeons aware of a potential pressure complication in posterior spine surgery for patients with hereditary spherocytosis (HS) and to present a plausible hypothesis for injury. Posterior spine surgery is common practice for adolescent idiopathic scoliosis (AIS). Common, less severe surgical risks include pressure ulcers; while rare, more severe pressure complications include rhabdomyolysis and compartment syndrome. In patients with HS, a familial hemolytic disorder with altered red cell deformability, it is unknown if their red cell disorder is an additional risk factor for pressure-related surgical injuries. Two patients with HS, an 18-year-old male and a 17-year-old female, were both post-splenectomy and underwent revision posterior spinal fusion and instrumentation for progressive AIS. Surgery lasted 9 hours and 7 hours respectively, with no intraoperative complications other than prolonged surgical time due to revision nature of the deformities. Thigh redness and swelling was noted in both patients directly deep to the thigh pads. Thigh myonecrosis was diagnosed with eventual recovery in both cases. Patients with HS may be at inherent more risk of pressure complications during posterior spine surgery. We propose that thigh myonecrosis occurs with decreased perfusion and hemolysis from HS erythrocytes’ inherent fragility, decreased deformability within capillaries, and prolonged microvasculature compression from positioning, ca...
Source: Journal of Pediatric Orthopaedics B - Category: Orthopaedics Tags: Spine Source Type: research

Related Links:

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
AbstractPurpose of ReviewMental stress –provoked myocardial ischemia (MSIMI) is an ischemic phenomenon provoked by the experience of psychologically stressful circumstances. While MSIMI was initially identified 50 years ago during activities of daily living through the use of wearable Holter monitor, subsequent research utilized the t echnologies of cardiac imaging—ventriculography and myocardial perfusion—under controlled conditions to pursue an understanding of pathophysiology and prognosis. This work revealed that MSIMI occurs in almost half of patients with stable coronary artery disease (CAD) an...
Source: Current Cardiology Reports - Category: Cardiology Source Type: research
AbstractPurpose of reviewPulmonary hypertension (PH) is a complex, progressive abnormal physiologic and hemodynamic state seen in many conditions. The purpose of this review is to discuss the updated clinical and hemodynamic classification systems and diagnostic criteria of PH, discuss the role of noninvasive imaging for diagnosing PH, and outline a diagnostic pathway to facilitate targeted therapies.Recent findingsPH is defined as a mean pulmonary arterial pressure (mPAP)>  20 mmHg since the sixth World Symposium on Pulmonary Hypertension (WSPH) in 2018, a lower threshold than the longstanding definition of...
Source: Current Treatment Options in Cardiovascular Medicine - Category: Cardiology Source Type: research
More News: Back Curves | Gas Gangrene (Myonecrosis) | Orthopaedics | Pediatrics | Perfusion | Pressure Sores | Rhabdomyolysis | Scoliosis | Splenectomy | Study