Klippel-Feil Syndrome: Pathogenesis, Diagnosis, and Management.

Klippel-Feil syndrome (KFS), or congenital fusion of the cervical vertebrae, has been thought to be an extremely rare diagnosis. However, recent literature suggests an increased prevalence, with a high proportion of asymptomatic individuals. Occurring as a sporadic mutation or associated with several genes, the pathogenesis involves failure of cervical somite segmentation and differentiation during embryogenesis. Most commonly, the C2-C3 and C5-C6 levels are involved. KFS is associated with other orthopaedic conditions including Sprengel deformity, congenital scoliosis, and cervical spine abnormalities, as well as several visceral pathologies. There are several classification systems, some based on the anatomic levels of fusion and others on its genetic inheritance. Management of patients with KFS primarily involves observation for asymptomatic individuals. Surgical treatment may be for neurologic complaints, correction of deformity, concomitant spinal anomalies, or for associated conditions and varies significantly. Participation in sports is an important consideration. Recommendations for contact sports or activities depend on both the level and the number of vertebrae involved in the fusion. A multidisciplinary team should be involved in the treatment plan and recommendations for complex presentations.

Hospital cost analysis of adolescent idiopathic scoliosis correction surgery in 125 consecutive cases.

BACKGROUND: Although achieving clinical success is the main goal in the surgical treatment of adolescent idiopathic scoliosis, it is becoming increasingly important to do so in a cost-effective manner. The goal of the present study was to determine the surgical and hospitalization costs, charges, and reimbursements for adolescent idiopathic scoliosis correction surgery at one institution. METHODS: We performed a retrospective review of 16,536 individual costs and charges, including overall reimbursements, for 125 consecutive patients who were managed surgically for the treatment of adolescent idiopathic scoliosis by three different surgeons between 2006 and 2007. Demographic, surgical, and radiographic data were recorded for each patient. Stepwise multiple linear regression analysis was employed to assess independent correlation with total cost and charge. Nonparametric descriptive statistics were calculated for total cost with use of the Lenke curve-classification system. RESULTS: The mean age of the patients was 15.2 years. The mean main thoracic curve measured 50 degrees, and the thoracolumbar curve measured 41 degrees. The cost varied with Lenke curve type: $29,955 for type 1, $31,414 for type 2, $31,975 for type 3, $60,754 for type 4, $32,652 for type 5, and $33,416 for type 6. Independently significant increases for total cost were found in association with the number of pedicle screws placed, the total number of vertebral levels fused, and the type of surgical approach (R(2) = 0.35, p

Clinical and radiographically/neuroimaging documented outcome in transforaminal lumbar interbody fusion.

OBJECT: Although transforaminal lumbar interbody fusion (TLIF) is an increasingly popular surgical technique, there are a limited number of studies in which investigators have stratified outcome data with respect to surgical indications or documented radiographically proven and clinical results with respect to disc space height (DSH). The authors conducted a study to evaluate the long-term outcomes after TLIF with respect to surgical indication and radiographic/neuroimaging results. METHODS: Thirty-three consecutive TLIF-treated patients underwent follow-up investigation for a mean of 37 months. Isthmic spondylolysis was present in eight patients, recurrent disc herniation in 14, and degenerative disc disease (DDD) in 11. The operative technique involved the placement of interbody structural allograft, pedicle screw instrumentation, and morcellized autograft in the anterior interbody space and the contralateral intertransverse gutter. Surgery was performed at L4-5 in 16 patients, L5-S1 in 14, L3-4 in two, and both L4-5 and L5-S1 in one patient. Preoperative symptoms were back pain (in 91% of cases), leg pain (in 94%), sensory loss (in 67%), and motor deficits (in 30%). Postoperatively, back pain was improved in 67% of the patients, unchanged in 27%, and worsened in 7%. Leg pain improved in 80% of patients, was unchanged in 10%, and worsened in 10%. Outcome, as measured using the Prolo Functional and Economic Scales, improved from a score of 4.9 to 7. In patients with spondylolysis and recurrent disc herniation outcomes were better than in those with DDD only. There was no correlation of outcome with symptom duration, patient age, or level of surgery. In an independent review of pre- and late postoperative radiographs no significant differences in lordosis angles, Cobb angles, or DSHs were found. Fusion occurred in all cases. CONCLUSIONS: The TLIF procedure was associated with good clinical outcomes and a high fusion rate but no change in the DSH. Patients who present with spondylolysis and recurrent herniations experience better outcome than those with degenerative disease alone.