ABSTRACT
BACKGROUND: Surgical treatment of spinal deformities in Duchenne muscular dystrophy (DMD) is influenced by a number of factors which have proven to be a difficult challenge. Each case should be carefully evaluated, considering not only the natural history of the spinal deformity, but also the patient's general condition. These should be thoroughly assessed through clinical and radiographic investigations together with other medical specialists. Life expectancy should be determined according to the cardio-respiratory function, and both preoperative and postoperative quality of life should be taken into consideration, trying to imagine the functional status of each patient after surgery. METHODS: From February 1985 to February 2000, 58 patients with spinal deformity in DMD were surgically treated. Of 25 patients that were operated on between 1985 and 1995, only 20 were followed-up after 5 years because 5 of them had died during this time. Therefore, the present study focuses on the results obtained in 20 cases. The 20 cases reviewed presented with a mean angular value of scoliosis equal to 48 degrees (range 10-92 degrees). Spinal fusion with our modified Luque technique [6] was performed in 19 cases, whereas CD instrumentation was applied in only one case. RESULTS: At the 5 year follow-up (range 5.6-10 years), the age ranged from 18 to 24 years and averaged 20.4 years. The postoperative angular value of scoliosis averaged 22 degrees (58%, range 0-43 degrees), the mean correction at follow-up was 28 degrees (range 0-60 degrees), and the mean loss of correction was equal to 6 degrees (range, 0-11 degrees). Vital capacity showed a slow progression, slightly inferior to its natural evolution in untreated patients. The severest complication was the death that occurred in one of the patients. CONCLUSIONS: According to the present study, an early surgery (angular value lower than 35-40 degrees) dramatically reduces the rate of risk factors associated with spinal deformities in DMD, and its advantages far exceed the disadvantages, above all in terms of quality of life.
Subject(s)
Muscular Dystrophy, Duchenne/surgery , Scoliosis/surgery , Adolescent , Adult , Follow-Up Studies , Humans , Spinal Curvatures/surgery , Spinal Fusion , Vital CapacityABSTRACT
The authors report their experience in the surgical treatment of the sequelae of congenital hip dysplasia, more specifically, 125 arthroplasties performed in 116 patients, with specific reference to the technical difficulties encountered and the various surgical methods used. This review suggests that prosthetization yields a high percentage of good results (77%) and constant remission of pain. Nonetheless, joint function, particularly when motion was severely compromised before surgery, or when dislocation was very severe (Crowe grades III and IV), is not always restored.
Subject(s)
Hip Dislocation, Congenital/surgery , Hip Prosthesis , Aged , Chronic Disease , Female , Hip Dislocation, Congenital/classification , Hip Dislocation, Congenital/complications , Hip Dislocation, Congenital/diagnostic imaging , Hip Joint/diagnostic imaging , Humans , Male , Middle Aged , Prosthesis Design , RadiographyABSTRACT
The authors review 101 cases of herniated lumbar intervertebral disc in children and adolescents treated by surgery. The most significant etiologic and pathogenetic factors in this series were early onset of disc degeneration, congenital lumbosacral malformations, and repeated trauma. The main clinical symptom was pain, usually sciatica, while neurological symptoms were less common than they are in adults. In all patients diagnosed correctly with the aid of appropriate imaging studies (myelography, CT scan, MRI), discectomy by means of conservative hemilaminectomy achieved satisfactory results, except in two cases of concomitant spinal instability due to spondylolysis and in one case of recurrence.
Subject(s)
Intervertebral Disc Displacement/surgery , Lumbar Vertebrae/surgery , Adolescent , Adult , Female , Follow-Up Studies , Humans , Intervertebral Disc Displacement/diagnostic imaging , Intervertebral Disc Displacement/etiology , Lumbar Vertebrae/diagnostic imaging , Male , Radiography , Retrospective Studies , Treatment OutcomeABSTRACT
Based on anatomo-pathological findings in fractures in bones affected with Paget's disease, the authors discuss problems related to treatment. One case is reported in which treatment involved intramedullary osteosynthesis with locked nailing and corrective osteotomy. This type of treatment achieved a dual purpose of obtaining fracture consolidation within a short amount of time, and correcting the deformity.
Subject(s)
Femoral Fractures/surgery , Fracture Fixation, Intramedullary , Osteitis Deformans/complications , Bone Nails , Bone Screws , Femoral Fractures/etiology , Humans , Male , Middle AgedABSTRACT
After reviewing the international literature the authors present three new cases of osteoid osteoma with vertebral body localisation, two in the lumbar region, and one in the cervical region. This rare localisation necessitates the use of accurate instrumental techniques, based on radiography, scintigraphy, and in particular, CT scanning, in order to arrive at a correct diagnosis as a prelude to the correct surgical treatment.
Subject(s)
Cervical Vertebrae/diagnostic imaging , Lumbar Vertebrae/diagnostic imaging , Osteoma, Osteoid/diagnostic imaging , Spinal Neoplasms/diagnostic imaging , Adolescent , Adult , Bone Transplantation , Female , Humans , Male , Osteoma, Osteoid/surgery , Spinal Fusion/methods , Spinal Neoplasms/surgery , Tomography, X-Ray ComputedABSTRACT
The authors report a case of osteoid osteoma localised in both laminae of D7. No bilateral case of this type has previously been reported in the literature.