The effect of Harrington instrumentation on the longitudinal axis rotation of the apical vertebra and on the spinal and rib-cage deformity in idiopathic scoliosis studied by computer tomography.

The effects of Harrington instrumentation on the longitudinal axis rotation of the vertebra, the kyphosis-lordosis, and the rib-cage deformity were investigated by computer tomography in 33 patients. No significant derotation was achieved. The sagittal diameter of the rib cage was reduced significantly with distraction rod instrumentation and further by additional application of a compression rod. The rib hump was reduced significantly only with distraction rod instrumentation. The obtained results indicate that despite instrumentation, the spine preserves an almost unchanged peripheral position in the rib cage.

Estimation of vertebral rotation and the spinal and rib cage deformity in scoliosis by computer tomography.

Computer tomography (CT) presents a method of determining longitudinal axis vertebral rotation and vertebral, spinal, and rib case deformity. Different rotation angles, distances, and indexes are defined and discussed. Radiation risks were evaluated and considered exceedingly small when compared to the ordinary spinal anteroposterior radiograph. In a model study the mean difference between actual vertebral rotation and measured rotation was 0.3 degrees if the vertebrae were tilted up to 20 degrees in either the frontal or sagittal plane. This accuracy was lost if the vertebrae were tilted 20 degrees in both the frontal and the sagittal plane. Computer tomography can be used for evaluation of the vertebral rotation in the frontal plane.

The longitudinal axis rotation of the apical vertebra, the vertebral, spinal, and rib cage deformity in idiopathic scoliosis studied by computer tomography.

The correlation between the lateral curve, the location and the length of the curve, and the longitudinal axis rotation of the apical vertebra has been studied in 65 patients with idiopathic scoliosis using computer-assisted tomography. This method provides the opportunity to describe the relationship between the rib hump, the longitudinal axis rotation, the lateral curve, and the kyphosis-lordosis with exceedingly small radiation doses. The vertebral rotation was found to be correlated to the lateral curve but not to the location of the length of the curve. The longitudinal axis rotation of the vertebrae is the most important factor for the development of the rib hump which is further accentuated by increased lordosis.

Scoliosis and pulmonary function.

The effect on pulmonary function of all three dimensions of the scoliotic deformity was analyzed with computer tomography in 33 patients with thoracic idiopathic scoliosis. Both static (total lung capacity [TLC], vital capacity [VC] and functional residual capacity [FRC] ) and dynamic volumes (forced expiratory volumes in one second [FEV-1]) were negatively correlated to the lateral deformity and, to a lesser degree, to rotation. Of the computer tomography variables reflecting kyphosis, the sagittal diameter was correlated positively to all lung volumes though negatively to the quotient FRC/TLC while the KLi was correlated positively to VC and FEV1. The conclusion is drawn that the Cobb angle gives the most accurate estimation of lung volume compromise and that operative treatment should aim of reducing the lateral dislocation of the vertebrae and at maintaining normal sagittal thoracic curve.

The effect of Harrington instrumentation on the sagittal configuration and mobility of the spine in scoliosis.

The spinal mobility and sagittal configuration in 96 scoliotic patients treated according to Harrington were investigated with a Debrunner kyphometer and a Myrin inclinometer. The more distal the fusion limit in the lumbar spine, the more reduced was the lumbar lordosis and flexion. The patients' own estimation of lumbar rigidity and pain, scored on visual analogue scales, increased as the fusion limit increased distally. The results for the thoracic spine's sagittal configuration and mobility were analogous but the trend was less pronounced. The patients' estimation of thoracic rigidity had little correlation with the number of segments fused. This study shows that fusion of the lumbar spine below L3 is to be avoided, except when specifically indicated. Furthermore, the study shows that the present technique does not adequately preserve the sagittal configuration of the thoracic and lumbar spine.

The sagittal configuration and mobility of the spine in idiopathic scoliosis.

The aim of this study is to see how the spinal sagittal configuration and mobility in 127 patients with idiopathic scoliosis are influenced by increasing scoliotic deformity and to determine when this deformity gets clinically significant compared to controls (n = 92). In patients with thoracic curves the degrees of thoracic kyphosis and lumbar lordosis were significantly less than those of the controls. Neither the kyphosis nor the lordosis were correlated to the Cobb angles. Even patients with small curves have straight spines in the sagittal plane; there is no tendency for the kyphosis and lordosis to decrease when the scoliotic deformity increases. This indicates that it is especially individuals with straight spines in the sagittal plane who are prone to develop scoliosis. It is also suggested that the limitation in spinal function for curves with Cobb angles below 50 degrees may be neglected.

Long-term results of Boston brace treatment on vertebral rotation in idiopathic scoliosis.

The long-term effect of Boston brace treatment was investigated by computed tomography measurements before treatment, after bracing, and at mean follow-up at 8.5 years in 25 patients with idiopathic scoliosis. At follow-up, the pretreatment Cobb angle, the vertebral rotation, the rib hump, and the translation of the apical vertebra were not significantly changed. The sagittal diameter of the thoracic cage was significantly decreased at follow-up. The current study demonstrates that the Boston brace does not improve, but prevents progression of vertebral rotation, translation, rib hump, and Cobb angle in idiopathic scoliosis. The reduced sagittal diameter is noteworthy and may be of importance for cosmesis and pulmonary function.

Long-term results of Harrington instrumentation in idiopathic scoliosis.

The long-term effect of Harrington instrumentation was investigated using posteroanterior radiographs and computed tomographic measurements preoperatively, postoperatively, and at a mean follow-up at 10.8 years in 33 patients with idiopathic scoliosis. No patient was lost from long-term follow-up. At follow-up, the mean Cobb angle was improved by 23.7 (40%) compared with the preoperative findings. The rotation of the apical vertebra was increased significantly. The rib hump, the translation of the apical vertebra, and the sagittal diameter of the thoracic cage were unchanged. At follow-up, the mean thoracic kyphosis was 17.3, and lumbar lordosis was 22.0. This study demonstrated that the long-term effect of Harrington instrumentation was limited to an improved Cobb angle; no correction of the rotational or sagittal deformities were achieved.

Anthropometric data relating to normal and scoliotic Scandinavian girls.

The increase in height and weight and the age at the menarche have been determined in girls with idiopathic scoliosis and in age-matched normal girls. The scoliotic girls were classified according to the position of the curve. The menarche was found to occur significantly later in girls with either a thoracolumbar or a double primary curve than in the control group; it was also significantly later in those two groups combined than in the girls with a right convex thoracic curve. At the time of the menarche, the girls with a thoracolumbar or a double primary curve were significantly taller than those in the control group. The girls with a double primary curve, and these together with girls with a thoracolumbar curve, were also significantly taller than those with a right convex thoracic curve. Those in the control group were significantly heavier, and in some age groups significantly taller, than children born during the period 1953-1958 and providing earlier Swedish research data. The average age at the menarche did not differ from that for a normal population for this country. The observed differences between the group with a right convex thoracic curve and that with a thoracolumbar or a double primary curve indicate that the pathomechanism, and even the etiology, may vary with the form of idiopathic scoliosis.

The immediate effect of Boston brace on renal function in patients with idiopathic scoliosis.

The immediate effect of the Boston brace on renal function was studied in 18 patients with idiopathic scoliosis ranging in age from ten to 17 years. Renal function was tested by clearances of inulin and PAH without and with brace applied. Glomerular filtration rate and effective renal plasma flow decreased significantly when the brace was applied, but to values within normal limits. When the brace was applied, the urinary sodium excretion, however, was significantly reduced to values significantly lower than that of controls. This might cause sodium retention if the pressure effect of the brace persists.

Cervical instability in skeletal dysplasia. Report of 6 surgically fused cases.

Six patients with skeletal dysplasias complicated by deformity or instability of the cervical spine were reviewed. Three patients had congenital spondyloepiphyseal dysplasia and 1 each suffered from Morquio's syndrome, pseudoachondroplasia, and chondrodystrophia calcificans congenita. Four patients had myelopathy of varying severity from slight weakness of one leg to tetraplegia. At a mean age of 6 (3-11) years, they underwent posterior fusion and immobilization in a halo brace. In all the cases the extent of postoperative neurologic recovery was, however, limited. Our cases illustrate the need of early diagnosis and fusion of cervical instability.

Long-term effect of Boston brace treatment on renal function in patients with idiopathic scoliosis.

The long-term effects of Boston brace treatment on renal function were studied in 20 patients with idiopathic scoliosis. Renal function was tested by clearances of inulin and para-aminohippurate sodium (PAH) when the brace was first applied as well as after four and 12 months of brace treatment. Each function test was performed without and with the brace. The glomerular filtration rate decreased when the brace was first applied, was unchanged after four months, and increased after 12 months. Renal plasma flow decreased when the brace was first applied but was unchanged after four and 12 months. Urinary sodium excretion decreased to values lower than those of control subjects when the brace was first applied, but an adaptive increase was noted after four and 12 months of brace treatment. The acute effects of brace application were observed even after four and 12 months of treatment; an increase in urinary sodium excretion was found when the brace was removed.

Mid-term effects of Cotrel-Dubousset instrumentation on the configuration of the spine and the thoracic cage in thoracic idiopathic scoliosis.

The effect of Cotrel-Dubousset instrumentation (CDI) on the three-dimensional spinal deformity in 24 consecutive patients with idiopathic scoliosis was investigated by posteroanterior and lateral radiographs and by computed tomography preoperatively, postoperatively, and at a mean follow-up of 3.2 years (range 2.0-5.3 years). At follow-up the mean Cobb angle was decreased by 73%, and the translation of the apical vertebra was significantly decreased by 33%. The sagittal contour was significantly improved with thoracic kyphosis T5-12 increased by 46% (6.9 degrees) and lumbar lordosis L1-5 increased by 28% (10.3 degrees) at follow-up. The sagittal diameter was significantly improved by 5 mm at follow-up. Although the vertebral rotation and the size of rib hump was improved postoperatively, this was followed by significant loss of correction, and at follow-up the vertebral rotation and the size of rib hump were not significantly better than preoperatively. The study indicates that while CDI improves the coronal and sagittal plane deformity permanently, the effect on vertetebral rotation and the rib hump deteriorates with time.

Limited effectiveness of intraoperative autotransfusion in major back surgery.

BACKGROUND AND OBJECTIVE: The efficiency of intraoperative autotransfusion in scoliosis surgery is poorly known but needs to be evaluated, not least because of the large blood losses in these patients. This is a retrospective analysis of transfusion requirements of 43 such patients. METHODS: Records from 43 patients were studied. During surgery, the shed blood was salvaged and washed in an autotransfusion device (AT1000 Autotransfusion Unit) and a suspension of red cells was reinfused. RESULTS: Fifty-eight per cent of the intraoperative blood loss was salvaged. The total blood loss during the patients' hospital stay was calculated from the haemoglobin balance; 24% of this loss was salvaged by the device. Moreover, 36 of the patients needed allogeneic blood transfusion. CONCLUSION: The efficiency of the autotransfusion device was relatively low in relation to the total extravasation, mainly because the postoperative blood loss is substantial.

Foot deformities in the newborn--incidence and prognosis.

In a consecutive screening of 2,401 newborn, a foot deformity was noted in 100 of the infants (4.2 percent). At follow-up 5-6 years later, the children with a foot deformity were reexamined and compared with normal controls. Seventy-six infants had some adduction deformity of the foot at birth. At reexamination, 87 percent of the examined children had normal feet. No association was observed between sleeping prone and the presence of adduction deformity at the reexamination. Pes calcaneovalgus was diagnosed in 18 newborn. Of those reexamined, all had normal feet. Up to the age of 6 years, 4.3 percent of the 2,401 had been referred to the department of orthopedics because of a foot deformity; 50 because of an adduction deformity, and in 10 of these children the deformity was observed at birth. The investigation indicates that no treatment is required for pes calcaneovalgus or adductus deformity confined to the forefoot.

Harrington instrumentation for thoracic and lumbar vertebral fractures.

Thirty-seven patients with fractures of the thoracic and lumbar spine treated with Harrington instrumentation were reviewed. Twenty-seven patients with a follow-up time of more than 2 years were summoned for a clinical and radiographic examination. This report presents the results related to reduction, stabilization, return of neural function, spinal posture and mobility, and residual disability. It is concluded that Harrington instrumentation can be performed without a substantial number of complications. Its major advantages are early mobilization and ambulation. The operative technique is discussed with special reference to the preservation of the normal configuration of the back. The value of computerized tomography in the preoperative assessment is stressed.