Segmental vessel sparing during convex growth arrest surgery--a modified technique.

BACKGROUND CONTEXT: Further evidence of the importance of segmental vessel ligation in the development of neurological complications has been recently published. The more levels the ligation encompasses, the higher the risk of spinal cord damage. Therefore, caution should be taken when several segmental arteries are to be ligated in the clinical setting. PURPOSE: To prevent ligation of segmental vessels during convex growth arrest surgery and thus decrease the risk of spinal cord ischemia and neurological injury. STUDY DESIGN: A report of a modified technique of convex growth arrest surgery used in two consecutive patients in our unit. METHODS: In two consecutive patients the segmental vessels were mobilized, elevated, and protected by using surgical slings. The rib graft was then slid beneath the elevated vessels into the prepared vertebral body channel and punched into place. The pleura then closed over the rib graft and spared vessels. RESULTS: Three of the five segmental vessels in the first patient were spared. All five segmental vessels were spared in the second patient. No neurological complications occurred. CONCLUSION: We report a straightforward technique, which obviates the need for segmental vessel ligation, and therefore decreases the risk of neurological injury in an already high-risk group.

Traction radiography performed under general anesthetic: a new technique for assessing idiopathic scoliosis curves.

STUDY DESIGN: A prospective review of 24 patients with late-onset idiopathic scoliosis. OBJECTIVES.: To compare curve flexibility measured using supine bending radiography and traction radiography; to examine the correlation of each technique with postoperative correction; and to determine the influence of each technique on the decision to perform concomitant anterior release surgery with posterior instrumentation. SUMMARY OF BACKGROUND DATA: Assessment of curve flexibility is important in decision making before surgical correction of scoliosis. Supine bending radiographs are presently the gold standard technique by which flexibility is assessed, but their reliability has been questioned. No literature has shown a conclusively superior role for traction radiography in assessing idiopathic scoliosis curves. METHODS: Each patient had erect anteroposterior radiographs and supine bending radiographs. On the day of surgery, traction radiography was performed under general anesthetic. The correction obtained in the Cobb angle between the bending and traction radiographs was compared. The influence of the traction radiography on the decision for anterior release surgery and its correlation with postoperative result was examined. RESULTS: Traction radiography demonstrated significantly greater curve flexibility than supine bending radiographs (P < 0.001). Eleven of 13 patients planned for anterior release surgery and posterior instrumentation avoided anterior release after review of the traction radiography. No significant difference was demonstrated between the traction radiography and postoperative correction (P = 0.13). CONCLUSION: Traction radiography is superior to supine bending radiography in assessing curve mobility before surgery. This method benefits patients by allowing them to avoid anterior release surgery and helps predict postoperative correction.