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1.
Neurosurg Clin N Am ; 34(1): 151-157, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36424055

RESUMO

The management of scoliosis in patients with Chiari I malformation and syringomyelia is a complex decision-making process, which is changing due to evolving evidence. Headache and scoliosis are common presenting symptoms of an underlying Chiari. History, physical examination, and screening with MRI are cornerstones of diagnosis. Posterior fossa decompression provides curve stabilization or regression in about half of patients. In those who require spinal fusion, careful attention must be paid to intraoperative neurological monitoring data to minimize risk of neurologic injury.


Assuntos
Malformação de Arnold-Chiari , Escoliose , Siringomielia , Humanos , Siringomielia/complicações , Siringomielia/diagnóstico por imagem , Siringomielia/cirurgia , Escoliose/complicações , Escoliose/diagnóstico por imagem , Escoliose/cirurgia , Descompressão Cirúrgica , Estudos Retrospectivos , Malformação de Arnold-Chiari/complicações , Malformação de Arnold-Chiari/diagnóstico por imagem , Malformação de Arnold-Chiari/cirurgia
2.
Neurosurg Clin N Am ; 34(1): 159-166, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36424056

RESUMO

CM-I-associated syringomyelia is a risk factor for scoliosis where a larger syrinx size is more likely to be associated with scoliosis. Therefore, the effect of syrinx on scoliosis progression may be alleviated by PFD. There is no difference in the need for fusion surgery between patients undergoing PFD with duraplasty vs. those undergoing extradural decompression; however, PFD with duraplasty is associated with an improvement in curve magnitude compared to extradural decompression alone. Further study on the comparison of PFD techniques for this cohort of patients is needed. PFD is a durable surgical option for patients with CM-I, syrinx, and scoliosis. Early decompression of CM-I in younger patients and those with smaller scoliosis curves at presentation is recommended as there is a higher likelihood of halting curve progression.


Assuntos
Malformação de Arnold-Chiari , Escoliose , Siringomielia , Humanos , Siringomielia/complicações , Siringomielia/cirurgia , Escoliose/complicações , Escoliose/cirurgia , Descompressão Cirúrgica/métodos , Resultado do Tratamento , Estudos Retrospectivos , Malformação de Arnold-Chiari/complicações , Malformação de Arnold-Chiari/cirurgia
3.
BMC Surg ; 22(1): 379, 2022 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-36333715

RESUMO

BACKGROUND: Although thoracic pedicle (TP) screw has gained increasingly popularity in the surgical treatment of adolescent idiopathic scoliosis (AIS) patients, questions remain about the accurate selection of entry point for TP screw placement in these patient. The main objective of the present study was to evaluate the accuracy of TP screw placement in AIS patients using the entry point identified by new landmarks. METHODS: Thirty-four thoracic AIS patients treated with posterior TP screw instrumentation were included. All these TP screws were inserted through the entry point identified by new landmarks with free-hand technique. Postoperative CT scans were obtained to evaluate the screw position. The perforations of the pedicle were classified as grade 0 (no perforation), grade 1 (≤ 2 mm), grade 2 (2.1-4 mm), grade 3 (4.1-6 mm) and grade 4 (6.1-8.0 mm). Screws in grade 0, displaced either medially or anteriorly in grade 1 and displaced laterally in grades 1 to 2 were considered acceptable. RESULTS: Of the 495 TP screws inserted, 34 (6.9%) screws were displaced with 7 screws (1.4%) displaced medially, 20 screws (4.1%) displaced laterally and 7 screws (1.4%) displaced anteriorly (P < 0.05). Among the 34 displaced screws, 11 screws (32.4%) were considered as grade 1, 14 screws (38.2%) as grade 2 and 9 screws (29.4%) as grade 3 (P < 0.05). The overall rate of acceptable screws was 97.8%. No screw-related complication was noted. CONCLUSION: Our new method for selecting the entry point of TP screw in AIS patients is convenient and can achieve high accuracy of screw placement, which is worthy of being widely popularized.


Assuntos
Cifose , Parafusos Pediculares , Escoliose , Fusão Vertebral , Humanos , Adolescente , Escoliose/diagnóstico por imagem , Escoliose/cirurgia , Fusão Vertebral/métodos , Vértebras Torácicas/cirurgia , Estudos Retrospectivos , Cifose/etiologia , Tomografia Computadorizada por Raios X/métodos
4.
BMC Surg ; 22(1): 405, 2022 Nov 22.
Artigo em Inglês | MEDLINE | ID: mdl-36419148

RESUMO

PURPOSE: This retrospective study was performed to analyze the clinical effects and complications of LSFCF in the surgical treatment of DLS combined with lumbar spinal stenosis (LSS). METHODS: A total of 26 eligible patients (mean age, 64.73 y; 17 men, 9 women) with DLS combined with LSS were included and LSFCF surgery was performed. An independent spine surgeon retrospectively reviewed the medical records and radiographs of all patients to evaluate surgical data and surgery-related complications. Preoperative, postoperative, and follow-up questionnaires were obtained to assess clinical outcomes. RESULTS: The average follow-up period of this study was 20.14 ± 5.21 months. The operation time and blood loss of patients underwent LSFCF were 129.33 ± 15.74 min and 356.13 ± 21.28 ml. The clinical effects of all patients in terms of visual analogue scale (VAS) and Oswestry disability index (ODI) have been significantly improved at the final follow-up postoperatively (P < 0.05). Complications such as infection, cerebrospinal fluid leakage, nerve injury, and internal fixation failure, etc. were not observed during the follow-up period. CONCLUSION: The LSFCF surgery is a safe and effective treatment for DLS patients combined with LSS.


Assuntos
Escoliose , Estenose Espinal , Masculino , Humanos , Feminino , Pessoa de Meia-Idade , Estenose Espinal/complicações , Estenose Espinal/cirurgia , Escoliose/cirurgia , Estudos Retrospectivos , Região Lombossacral , Resultado do Tratamento
5.
J Orthop Surg (Hong Kong) ; 30(3): 10225536221137753, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36420934

RESUMO

PURPOSE: Over the past 12 years, vertebral body tethering (VBT) has been gradually promoted for treating scoliosis, but there are few published studies, with only short-term follow-up. This study aimed to systematically review VBT efficacy and safety for treating scoliosis. METHODS: PubMed, Web of Science, Embase, and the Cochrane Library were searched for studies on VBT treatment of scoliosis published up to November 2021. Two researchers independently screened the literature, extracted data, and assessed the risk of bias in included studies. Data on clinical efficacy, unplanned reoperations, and complications were extracted. The meta-analysis was performed with R 4.1.0. RESULTS: Twenty-six studies involving 1045 patients were included in the meta-analysis. The correction rate of major curve immediately post-operation was 46.6% ± 13.8% (16%-69%) and that at final follow-up was 53.2% ± 17.9% (16%-79%). The single-arm meta-analysis results of all included studies showed that VBT was effective in general. The overall clinical success rate was 73.02% (95% confidence interval [CI]: 68.31%-78.05%). The pooled overall unplanned reoperation rate was 8.66% (95% CI: 5.53%-13.31%). The overall incidence rate of complications was 36.8% (95% CI: 23.9%-49.7%). The subgroup analysis based on follow-up time indicated that patients with follow-up time >36 months had increased clinical success rate, unplanned reoperation rate, and incidence rate of complications compared with those with <36 months' follow-up time. The preliminary results showed that after 36 months of follow-up, only 7.17% (95% CI: 4.81%-10.55%) of patients required posterior spinal fusion (PSF) surgery and nearly 93% of patients avoided spinal fusion surgeries. CONCLUSIONS: The current evidence from at least 3-year follow-up in different countries indicates that VBT is an effective surgical approach for treating scoliosis, with 73.88% of patients achieving clinical success. Nevertheless, about one in seven patients (15.8%) required unplanned reoperations, but only 7.17% required PSF. About half (52.17%) of the patients experienced complications. Due to the limitation of the study number and quality, our conclusion may be biased and requires verification by further studies with longer follow-up times.


Assuntos
Escoliose , Fusão Vertebral , Humanos , Escoliose/cirurgia , Escoliose/epidemiologia , Corpo Vertebral , Fusão Vertebral/métodos , Resultado do Tratamento , Reoperação
6.
J Orthop Surg Res ; 17(1): 491, 2022 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-36384684

RESUMO

STUDY DESIGN: A retrospective case-control study. OBJECTIVE: To evaluate whether Ponte osteotomy improves thoracic kyphosis and to determine its clinical efficacy in hypokyphotic adolescent idiopathic scoliosis (AIS). METHODS: Eighty consecutive Lenke type 1 AIS patients with hypokyphotic curves who underwent posterior spinal fusion by one spine surgeon at a single institution were recruited. According to whether Ponte osteotomy was performed, the patients were divided into two groups. The preoperative, immediate, one-year postoperative, and two-year postoperative radiographs were analyzed. The demographic characteristics, surgical information, radiographic parameters, Scoliosis Research Societye-22 (SRS-22) questionnaire, and complications were compared. RESULTS: The sagittal alignment and coronal alignment were both improved in the Ponte group and the control group postoperatively. There was no significant difference in the preoperative parameters between the two groups, except the TL/L, CB, and LL. Significant differences were found in the MT (15.18° ± 2.84° vs. 20.33° ± 3.75°, P < 0.001) and TK (24.23° ± 2.71° vs. 19.93° ± 2.38°, P < 0.001) at the two-year follow-up. The Ponte group had a longer operation time and more intraoperative blood loss. No significant difference was observed between the groups in the SRS-22 scores at the final follow-up. CONCLUSIONS: Ponte osteotomy could obtain better coronal correction and sagittal contour restoration in AIS patients with hypokyphosis. However, Ponte osteotomies might lead to more intraoperative blood loss and longer operation time. Moreover, no discrepancy was found in the postoperative health-related quality of life of the included patients. Therefore, we considered that the Ponte osteotomy may be an alternative method to restore the desired thoracic kyphosis, which needs further study.


Assuntos
Cifose , Escoliose , Humanos , Adolescente , Escoliose/diagnóstico por imagem , Escoliose/cirurgia , Estudos Retrospectivos , Perda Sanguínea Cirúrgica , Estudos de Casos e Controles , Qualidade de Vida , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Cifose/diagnóstico por imagem , Cifose/cirurgia , Osteotomia/métodos , Resultado do Tratamento , Ponte
7.
Eur Rev Med Pharmacol Sci ; 26(21): 7960-7966, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36394745

RESUMO

OBJECTIVE: To investigate the correlation between scoliosis direction and oblique lateral lumbar interbody fusion (OLIF) operation channel angle in patients with degenerative lumbar scoliosis. PATIENTS AND METHODS: 80 cases of degenerative lumbar scoliosis and 40 cases of lumbar degenerative diseases without scoliosis were retrospectively studied in our hospital from January 2018 to January 2021. The general data and imaging indexes of all patients were analyzed, and the correlation between the rotation angle of vertebral body and the channel angle of OLIF operation was evaluated. RESULTS: The distance between abdominal aorta and psoas muscle in L2-3 and L3-4 segments, and the distance between abdominal aorta and lumbar sympathetic trunk in L3-4 segments, as well as the angles of OLIF operation channels in L2-3, L3-4 and L4-5 segments of the right-scoliosis group were all significantly greater than those in the no-scoliosis group (p < 0.05). The distance between abdominal aorta and lumbar sympathetic trunk in L4-5 segments of the left-scoliosis group was significantly greater than that in the no-scoliosis group and the right-scoliosis group (p < 0.05). The angle of OLIF operation channel in L3-4 and L4-5 segments of the left-scoliosis group was significantly smaller than that in the non-scoliosis group (p < 0.05), and the distance between psoas major and transverse axis of vertebral body in L2-3 and L3-4 segments of the left-scoliosis group was significantly greater than that in the non-scoliosis group (p < 0.05). The distance between adjacent vertebral bodies in L2-3 and L3-4 segments of the right-scoliosis group was significantly larger than that in the non-scoliosis group (p < 0.05). The distance between psoas major and transverse axis of vertebral body in L4-5 segment of the left-scoliosis group was significantly larger than that in the no-scoliosis group and the right-scoliosis group (p < 0.05). Correlation analysis showed that there was a negative correlation between OLIF operation channel angle and vertebral rotation angle in the left scoliosis group (p < 0.05), and a positive correlation between OLIF operation channel angle and vertebral rotation angle in the right scoliosis group (p < 0.05). CONCLUSIONS: The scoliosis direction of patients with degenerative lumbar scoliosis can directly affect the angle of OLIF operation channel, so targeted design and operation adjustment should be given according to the scoliosis direction of patients before operation.


Assuntos
Escoliose , Fusão Vertebral , Humanos , Estudos Retrospectivos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/cirurgia , Escoliose/diagnóstico por imagem , Escoliose/cirurgia , Fusão Vertebral/métodos , Rotação
8.
BMC Musculoskelet Disord ; 23(1): 947, 2022 Nov 02.
Artigo em Inglês | MEDLINE | ID: mdl-36324134

RESUMO

BACKGROUND: In clinical practice, there are a significant percentage of Lenke 2 AIS patients suffered from medial shoulder imbalance (MSI) despite achieving good lateral shoulder balance (LSB) following surgery. However, there are few studies evaluating the features of the medial shoulder. The objective of this study was to determine the incidence and independent risk factors of MSI with LSB after Lenke 2 AIS corrective surgery. METHODS: One hundred and twenty Lenke 2 AIS patients with LSB at the last follow-up were reviewed from 2009 to 2018. Preoperative, and 3-month and the last postoperative follow-up radiographs were measured using a number of specific measurements. At the last follow-up, patients were divided into medial shoulder balance (MSB) group and the MSI group according to whether the T1 tilt was greater than 3°. A stepwise multiple linear regression analysis was used to examine the independent risk factors for MSI. Scoliosis Research Society (SRS)-30 questionnaire was used to assess clinical outcomes. RESULTS: Up to 69.2% of patients suffered from MSI with LSB after Lenke Type 2 AIS corrective surgery. Multiple regression showed that postoperative upper instrumented vertebra tilt (UIVt), proximal thoracic curve (PTC), the ratio of PTC and main thoracic curves (PTC/MTC) and T2 vertebra rotation ratio (T2-VR) were significant predictors for MSI (UIVt: b = 0.398, p < 0.001; PTC/MTC: b = 2.085, p < 0.001; PTC: b = 0.155, p < 0.001; T2-VR: b = 3.536, p = 0.008; adjusted R2 = 0.711). 72 patients completed the SRS-30 questionnaire survey, and the MSB group were scored the higher (p ≤ 0.001) in self-image domain (4.18 ± 0.43 vs. 3.70 ± 0.35), satisfaction domain (4.39 ± 0.54 vs. 3.95 ± 0.46) and total average (4.31 ± 0.23 vs. 4.11 ± 0.19). CONCLUSION: Although the patients with Lenke 2 AIS achieve LSB after corrective surgery, up to 69.2% of them suffered from MSI. Postoperative UIVt, PTC, PTC/MTC and T2-VR were significant predictors for MSI. Sufficient correction of these variables may facilitate the achievement of MSB.


Assuntos
Cifose , Escoliose , Fusão Vertebral , Humanos , Adolescente , Escoliose/diagnóstico por imagem , Escoliose/cirurgia , Ombro/diagnóstico por imagem , Ombro/cirurgia , Fusão Vertebral/efeitos adversos , Incidência , Estudos Retrospectivos , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Fatores de Risco , Seguimentos
9.
J Med Case Rep ; 16(1): 446, 2022 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-36443749

RESUMO

BACKGROUND: Aneurysmal bone cysts are benign bone tumors that not uncommonly involves the spine. However, this involvement can cause scoliosis, albeit rarely. This report focuses on the importance of proper management for complete tumor resection to prevent recurrence and spinal deformity. CASE PRESENTATION: A 12-year-old Middle Eastern boy, with a history of T11 aneurysmal bone cyst resection and bone grafting carried out at another hospital, presented with spine deformity of 4 months' duration. The deformity was not associated with pain or neurological deficit. A whole-spine magnetic resonance imaging with contrast confirmed the recurrence of the aneurysmal bone cyst. Posterior spinal instrumentation with corpectomy of T11 was then performed, and confirmed with histopathology the recurrence of aneurysmal bone cyst. Two years post-corpectomy, deformity correction was done from T5-L4. CONCLUSION: Management of aneurysmal bone cysts requires meticulous planning and full excision to prevent recurrence, especially in the growing spine. If neglected, it can cause major spinal deformities and cord compression, which places a medical burden on the patient and family. To avoid such complications, treating aneurysmal bone cysts along with scoliosis correction can prevent deformity progression.


Assuntos
Cistos Ósseos Aneurismáticos , Escoliose , Masculino , Humanos , Criança , Escoliose/complicações , Escoliose/diagnóstico por imagem , Escoliose/cirurgia , Cistos Ósseos Aneurismáticos/diagnóstico , Cistos Ósseos Aneurismáticos/diagnóstico por imagem , Coluna Vertebral , Procedimentos Neurocirúrgicos , Transplante Ósseo
10.
Acta Chir Orthop Traumatol Cech ; 89(5): 376-379, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36322039

RESUMO

PURPOSE OF THE STUDY To identify risk factors associated with developing Clostridium difficile infection (CDI) in adolescent idiopathic scoliosis patients after surgery and to describe the clinical presentation of CDI in these patients. Clostridium difficile colitis is reportedly increasing in hospitalized patients and can have a negative impact on patient outcomes. No data exist on CDI rates and its consequences on patient undergoing surgery for adolescent idiopathic scoliosis. MATERIAL AND METHODS A retrospective database review of patients who underwent elective idiopathic scoliosis surgery between January 2019 to June 2021 was conducted. The population was divided into patients who developed Clostridium difficile colitis and those who did not. RESULTS A total of 128 patients were included in the study. We did not find notable risk factors for the development of CDI. In 2 patients diagnosis of CDI, was made. Length of hospital stays, and readmissions were significantly higher in patients with CDI. CONCLUSIONS CDI is a rare post-surgical complication in patients who undergo surgery for idiopathic scoliosis. Currently, we cannot identify predisposing factors for the development of CDI in adolescent idiopathic scoliosis patients. A high index of suspicion is necessary for timely diagnosis and treatment in patients presenting with abdominal symptoms around post-operative day 5 after surgical treatment for idiopathic scoliosis. Key words: Clostridium difficile infection, adolescent idiopathic scoliosis, abdominal pain, diarrhea.


Assuntos
Clostridioides difficile , Infecções por Clostridium , Colite , Escoliose , Humanos , Adolescente , Estudos Retrospectivos , Escoliose/cirurgia , Infecções por Clostridium/diagnóstico , Infecções por Clostridium/epidemiologia , Infecções por Clostridium/etiologia , Fatores de Risco
11.
Sci Rep ; 12(1): 16996, 2022 Oct 10.
Artigo em Inglês | MEDLINE | ID: mdl-36216882

RESUMO

No validated systems exist for selecting the upper instrumented vertebra (UIV) for optimal postoperative shoulder balance in Lenke type 2 adolescent idiopathic scoliosis (AIS). This study evaluated a new method for shoulder balance prediction using the modified Shinshu line (MSL) for UIV selection in AIS Lenke type 2 curves. Fifty-five consecutive AIS patients receiving posterior spinal fusion (PSF) for a Lenke type 2 AIS curve were retrospectively analyzed according to several UIV determination models. Shoulder imbalance was judged as absolute radiographic shoulder height ≥ 10 mm at the 2-year observational endpoint. The MSL was the line between the center of the spinous process of C7 and that of the lowest instrumented vertebra. The vertebral body first touched proximally by the MSL was defined as the MSL vertebra (MSLV) and recommended as the UIV. The group with the UIV matching the MSLV had a significantly lower prevalence of shoulder imbalance of 23% (odds ratio 4.08, 95% CI 1.22-13.7, P = 0.02). Setting the MSLV as the UIV in PSF for AIS Lenke type 2 may reduce the prevalence of postoperative shoulder imbalance.


Assuntos
Cifose , Escoliose , Fusão Vertebral , Adolescente , Seguimentos , Humanos , Estudos Retrospectivos , Escoliose/diagnóstico por imagem , Escoliose/cirurgia , Fusão Vertebral/métodos , Vértebras Torácicas/cirurgia , Resultado do Tratamento
12.
JBJS Case Connect ; 12(4)2022 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-36302062

RESUMO

CASE: Congenital Zika syndrome (CZS) has been noted after the South American pandemic of Zika virus which peaked in 2015 to 2016, and the associated sequelae are still being described. Scoliosis has been noted in patients with CZS; however, there is a paucity of literature on the prevalence or management of scoliosis secondary to this condition. We report the case of a 5-year-old girl with severe neuromuscular scoliosis due to CZS that was managed with halo-gravity traction, followed by a growth-friendly construct. CONCLUSION: This case report highlights the need for more research focusing on the survivors of the Zika pandemic.


Assuntos
Doenças Neuromusculares , Escoliose , Fusão Vertebral , Infecção por Zika virus , Zika virus , Feminino , Humanos , Pré-Escolar , Escoliose/cirurgia , Escoliose/complicações , Infecção por Zika virus/complicações , Infecção por Zika virus/congênito , Infecção por Zika virus/epidemiologia , Tração/efeitos adversos , Fusão Vertebral/efeitos adversos
13.
Spine Deform ; 10(Suppl 1): 1-27, 2022 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-36201157
14.
Medicine (Baltimore) ; 101(41): e31139, 2022 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-36253975

RESUMO

Spinal abnormality surgery, including surgery for ankylosing spondylitis and idiopathic scoliosis, can present significant challenges to anesthesiologists because of the potential difficult airway. The bedside screening tests routinely used to detect difficult airways are highly variable. Pharynx volume calculated using three-dimensional (3D) computed tomography (CT) may play a role in predicting difficult airways. We conducted a retrospective cohort study on patients (aged ≥14 years) who received orthopedic surgery for ankylosing spondylitis/idiopathic scoliosis under general anesthesia. Volume of the pharynx air space was calculated through volume rendering technique by 3D reconstruction of patients' cervical spine CT. Patients were divided into 2 groups according to their pharynx volume, pharyngeal volume lower than 16 mL (n = 11) and equal or higher than 16 mL (n = 13). Pharynx volume in low volume group was 10.4 ±â€…3.6 mL (n = 11), and the counterpart in high volume group was 20.8 ±â€…5.5 mL (n = 13). The incidence of difficult intubation was significantly higher in low pharynx volume group than in high pharynx volume group (54.5% (6/11) vs 7.6% (1/13), P = .023). Bedside screening tests including modified Mallampati test, inter-incisor gap and thyromental distance, or radiological variables such as anterior neck soft tissue thickness to vocal cords were not different between the 2 groups. Smaller pharynx volume played an important role in difficult airways for patients undergoing orthopedic surgery for ankylosing spondylitis/idiopathic scoliosis.


Assuntos
Escoliose , Espondilite Anquilosante , Humanos , Intubação Intratraqueal/métodos , Faringe/diagnóstico por imagem , Estudos Retrospectivos , Escoliose/diagnóstico por imagem , Escoliose/cirurgia , Espondilite Anquilosante/diagnóstico por imagem , Espondilite Anquilosante/cirurgia , Tomografia Computadorizada por Raios X
15.
Med Eng Phys ; 108: 103879, 2022 10.
Artigo em Inglês | MEDLINE | ID: mdl-36195358

RESUMO

Adolescent idiopathic scoliosis (AIS) is a three-dimensional deformity of the spine. Spine slenderness, which represents its potential instability to buckling under compressive loads, was shown to be higher in AIS patients than non-scoliotic subjects, but it is not clear at what stage of the progression this difference appeared, nor if slenderness could be used as an early sign of progression. In this study, we hypothesized that slenderness could be an early sign of progression. One-hundred thirty-eight patients and 93 non-scoliotic subjects were included. They underwent standing biplanar radiography and 3D reconstruction of the spine, which allowed computing vertebra and disc slenderness ratio. Then, patients were followed until progression of the deformity or skeletal maturity (stable patients). Vertebral slenderness ratio in AIS patients varied between 2.9 [2.7; 3.0] (T9) and 3.4 [3.2; 3.6] (T1), while disc slenderness ranged from 0.6 [0.6; 0.7] at T6-T7 to 1.2 [1.1; 1.3] at L4-L5. Slenderness ratio increased with age, while disc slenderness tended to decrease with age and Cobb angle. Slenderness was similar between progressive and stable patients, and also between patients and non-scoliotic subjects. In conclusion, spinal slenderness does not appear to be an early sign of progression. Further studies should analyse the development of slenderness during growth, and how it could be affected by non-operative treatment.


Assuntos
Escoliose , Adolescente , Humanos , Radiografia , Escoliose/diagnóstico por imagem , Escoliose/cirurgia , Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/cirurgia
16.
Can J Anaesth ; 69(12): 1556-1561, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-36198993

RESUMO

PURPOSE: The prone position can lead to anatomical compression of the thoracic cavity resulting in reduced cardiac output, especially in the context of chest wall deformities commonly present in patients with scoliosis. There are no protocols for using transesophageal echocardiography (TEE) to optimize prone positioning and for safe use of TEE during cases requiring neuromonitoring. CLINICAL FEATURES: We present a case of a 23-yr-old male with Cornelia de Lange syndrome undergoing elective posterior spinal fusion for syndromic scoliosis who developed severe refractory hypotension and cardiac arrest in the prone position. After hemodynamic stabilization in the intensive care unit, the patient returned to the operating room on postoperative day 2 for completion of his spinal fusion. Transesophageal echocardiography determined the optimal position of longitudinal bolster placements associated with minimal left ventricular compression in the supine position. The patient was then proned and intraoperative hemodynamics during the second surgery remained stable. Owing to the special considerations of using TEE in the prone position with neuromonitoring, we describe technical aspects to consider to protect the equipment and patient. CONCLUSION: Patients with compliant chest walls or thoracic deformities are at risk of hemodynamic instability in the prone position. Intraoperative TEE can be used in the supine patient prior to proning to determine optimal longitudinal bolster positioning to minimize cardiac compression. Transesophageal echocardiography used during spine surgery in the prone position with neuromonitoring and motor-evoked potentials requires special considerations for patient safety.


RéSUMé: OBJECTIF: La position ventrale peut entraîner une compression anatomique de la cavité thoracique provoquant une réduction du débit cardiaque, en particulier dans le contexte de déformations de la paroi thoracique, fréquentes chez les patients atteints de scoliose. Il n'existe aucun protocole guidant l'utilisation de l'échocardiographie transœsophagienne (ETO) pour optimiser le positionnement ventral et pour favoriser l'utilisation sécuritaire de l'ETO dans les cas nécessitant un neuro-monitorage. CARACTéRISTIQUES CLINIQUES: Nous présentons le cas d'un homme de 23 ans atteint d'un syndrome de Cornelia de Lange bénéficiant d'une fusion spinale postérieure non urgente pour traiter une scoliose syndromique; le patient a manifesté une hypotension réfractaire sévère et un arrêt cardiaque en position ventrale. Après stabilisation hémodynamique à l'unité de soins intensifs, le patient est retourné en salle d'opération au jour postopératoire 2 pour terminer sa fusion spinale. L'échocardiographie transœsophagienne a permis de déterminer la position optimale des traversins longitudinaux qui était associée à une compression ventriculaire gauche minimale en décubitus dorsal. Le patient a ensuite été positionné sur le ventre, et les valeurs hémodynamiques peropératoires sont restées stables au cours de la deuxième chirurgie. En raison des considérations particulières de l'utilisation de l'ETO en position ventrale avec neuro-monitorage, nous décrivons les aspects techniques à prendre en compte pour protéger l'équipement et le patient. CONCLUSION: Les patients présentant des parois thoraciques compliantes ou des déformations thoraciques sont à risque d'instabilité hémodynamique en position ventrale. L'ETO peropératoire peut être utilisée chez le patient en décubitus dorsal avant le positionnement ventral pour déterminer le positionnement optimal des traversins longitudinaux afin de minimiser la compression cardiaque. L'utilisation de l'échocardiographie transœsophagienne lors d'une chirurgie du rachis en position ventrale avec neuro-monitorage et potentiels évoqués moteurs nécessite des considérations particulières en ce qui a trait à la sécurité des patients.


Assuntos
Ecocardiografia Transesofagiana , Escoliose , Humanos , Masculino , Escoliose/cirurgia , Decúbito Ventral/fisiologia , Hemodinâmica/fisiologia , Posicionamento do Paciente
17.
Acta Orthop Traumatol Turc ; 56(5): 327-332, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36300557

RESUMO

OBJECTIVE: This study aimed to compare the effect of the ultrasound (US) guided erector spinae plane block (ESPB) on pain scores, opioid requirement, patient satisfaction, and the length of hospital stay with standard analgesia methods following scoliosis surgery. METHODS: Twenty-seven patients (17 females, 10 males; mean age=15.59 ± 3.24 years) who underwent scoliosis surgery with preoperative bilateral bilevel US-guided ESPB were the sample group, and the remaining 30 patients (20 females, 10 males; mean age = 15.57 ± 2.75 years) without ESPB were the control group. Bilateral bilevel injection ESPB was performed at two levels (T4 and T10). Postoperative pain scores, morphine consumption, patient satisfaction scores, and the number of patients requiring rescue analgesia were recorded. A visual analog scale (VAS) was used to score postoperative pain. RESULTS: VAS at rest and when mobile, as well as postoperative cumulative morphine consumption in the first postoperative 24 h, was significantly lower in the ESPB group. Thirteen patients in the control group but no in the ESPB group required rescue analgesics in the postoperative period. Both the time to the requirement of the initial dose of PCA and patient satisfaction scores were significantly higher in the ESPB group (P < 0.001 for both). CONCLUSION: Given the need for improved recovery of the patients, ESPB seems to be an essential analgesic technique that may reduce both opioid consumption and the severity of the pain, thus increasing the satisfaction of the patients and decreasing the length of hospital stay. LEVEL OF EVIDENCE: Level IV, Therapeutic Study.


Assuntos
Bloqueio Nervoso , Escoliose , Masculino , Feminino , Humanos , Criança , Adolescente , Bloqueio Nervoso/métodos , Analgésicos Opioides/uso terapêutico , Estudos Retrospectivos , Escoliose/cirurgia , Dor Pós-Operatória/prevenção & controle , Dor Pós-Operatória/tratamento farmacológico , Derivados da Morfina/uso terapêutico
18.
Comput Intell Neurosci ; 2022: 5730856, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36188703

RESUMO

We compared the pre-, intra-, and postoperative characteristics among three groups of patients who underwent posterior vertebral column resection (PVCR) to clarify age-related characteristics and to guide patient management, surgical planning, and complication avoiding. We compared and analyzed the etiology, surgical events, outcomes, and complications among pediatric, adolescent, and adult patients who underwent PVCR in a single-center database retrospectively. Patients were categorized into pediatric (0-12 yr), adolescent (13-19 yr), and adult (>20 yr) cohorts. Demographics, surgical events, clinical and radiographic results, and major complications were compared between groups. A total of 87 patients with a mean follow-up 42 (24-96) months were identified. Pediatric group (14) had a high frequency of congenital vertebral and cardiac abnormal, adolescents (47) presented more intracanal malformations, and idiopathic was common in the adult group (26). Although pediatric patients had shorter fusion levels than adolescent and adult, their mean resected vertebrae (1.91), percentage of blood loss (estimated blood loss per total blood volume) (201.9%), and operative time were much higher. The coronal/sagittal correction rate was significantly higher in the pediatric group (73.6%/72.3%). Overall, surgical complications were more frequent in adults, particularly neuromonitoring alert and implant failure. However, more severe complications were noted in younger patients. For pediatric patients with PVCR, poor physiological conditions and frequent comorbidities indicated cautious patient selection and sufficient preoperative preparation. The higher correction rate may be due to the excellent compliance of the spinal cord. For adult patients, preoperative traction and adjusting the tension of the spinal cord during surgery could contribute to neurological safety.


Assuntos
Procedimentos Ortopédicos , Escoliose , Adolescente , Adulto , Criança , Humanos , Procedimentos Ortopédicos/efeitos adversos , Procedimentos Ortopédicos/métodos , Estudos Retrospectivos , Escoliose/etiologia , Escoliose/cirurgia , Coluna Vertebral/cirurgia , Resultado do Tratamento
19.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 36(10): 1305-1311, 2022 Oct 15.
Artigo em Chinês | MEDLINE | ID: mdl-36310470

RESUMO

Objective: To review the research progress of upper instrumented vertebra (UIV) selection strategy for long-segment fixation (LSF) in adult degenerative scoliosis (ADS). Methods: The relevant domestic and foreign literature in recent years was reviewed, and the selection strategy of sagittal and coronal UIV for LSF in ADS patients, the relationship between UIV selection and proximal junctional kyphosis (PJK) and proximal junctional failure (PJF), the impact of minimally invasive spine surgery on the selection strategy of UIV were summarized. Results: LSF can restore the biomechanical balance of the spine and reconstruct the physiological curve of the spine for ADS patients. LSF should be selected for ADS patients with severe scoliosis, vertebral rotation, and severe sagittal imbalance. For patients with poor general condition, UIV can choose the thoracic and lumbar vertebrae to reduce the operation time and intraoperative bleeding, which is conducive to early mobilization and reduce complications; for patients with good general condition, the upper thoracic vertebrae can be considered if necessary, in order to achieve satisfactory long-term effectiveness. However, the lower thoracic vertebra (T 9、10) should be selected as much as possible to reduce postoperative complications such as PJK and PJF. In recent years, a new reference marker, the first coronal reverse vertebra was proposed, to guide the selection of UIV. But a large-sample multicenter randomized controlled study is needed to further verify its reliability. Studies have shown that different races and different living habits would lead to different parameters of the spine and pelvis, which would affect the selection of UIV. Minimally invasive surgeries have achieved satisfactory results in the treatment of ADS, but the UIV selection strategy in specific applications needs to be further studied. Conclusion: The selection strategy of UIV in LSF has not yet been unified. The selection of UIV in the sagittal plane of the upper thoracic spine, the lower thoracic spine, or the thoracolumbar spine should comprehensively consider the biomechanical balance of the spine and the general condition of the patient, as well as the relationship between the upper horizontal vertebra, the upper neutral vertebra, and the upper end vertebra on the coronal plane.


Assuntos
Cifose , Escoliose , Fusão Vertebral , Adulto , Humanos , Escoliose/cirurgia , Fusão Vertebral/métodos , Reprodutibilidade dos Testes , Cifose/cirurgia , Vértebras Torácicas/cirurgia , Vértebras Lombares/cirurgia , Complicações Pós-Operatórias , Estudos Retrospectivos , Estudos Multicêntricos como Assunto
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