Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.347
Filtrar
1.
Bone Joint J ; 102-B(2): 261-267, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32009441

RESUMO

AIMS: It is uncertain whether instrumented spinal fixation in nonambulatory children with neuromuscular scoliosis should finish at L5 or be extended to the pelvis. Pelvic fixation has been shown to be associated with up to 30% complication rates, but is regarded by some as the standard for correction of deformity in these conditions. The incidence of failure when comparing the most caudal level of instrumentation, either L5 or the pelvis, using all-pedicle screw instrumentation has not previously been reported. In this retrospective study, we compared nonambulatory patients undergoing surgery at two centres: one that routinely instrumented to L5 and the other to the pelvis. METHODS: In all, 91 nonambulatory patients with neuromuscular scoliosis were included. All underwent surgery using bilateral, segmental, pedicle screw instrumentation. A total of 40 patients underwent fusion to L5 and 51 had their fixation extended to the pelvis. The two groups were assessed for differences in terms of clinical and radiological findings, as well as complications. RESULTS: The main curve (MC) was a mean of 90° (40° to 141°) preoperatively and 46° (15° to 82°) at two-year follow-up in the L5 group, and 82° (33° to 116°) and 19° (1° to 60°) in the pelvic group (p < 0.001 at follow-up). Correction of MC and pelvic obliquity (POB) were statistically greater in the pelvic group (p < 0.001). There was no statistically significant difference in the operating time, blood loss, or complications. Loss of MC correction (> 10°) was more common in patients fixated to the pelvis (23% vs 3%; p = 0.032), while loss of pelvic obliquity correction was more frequent in the L5 group (25% vs 0%; p = 0.007). Risk factors for loss of correction (either POB or MC) included preoperative coronal imbalance (> 50 mm, odds ratio (OR) 11.5, 95%confidence interval (CI) 2.0 to 65; p = 0.006) and postoperative sagittal imbalance (> 25 mm, OR 11.0, 95% CI1.9 to 65; p = 0.008). CONCLUSION: We found that patients undergoing pelvic fixation had a greater correction of MC and POB. The rate of complications was not different. Preoperative coronal and postoperative sagittal imbalance were associated with increased risks of loss of correction, regardless of extent of fixation. Therefore, we recommend pelvic fixation in all nonambulatory children with neuromuscular scoliosis where coronal or sagittal imbalance are present preoperatively. Cite this article: Bone Joint J 2020;102-B(2):261-267.


Assuntos
Vértebras Lombares/cirurgia , Sacro/cirurgia , Escoliose/cirurgia , Fusão Vertebral/métodos , Adolescente , Criança , Feminino , Seguimentos , Humanos , Masculino , Limitação da Mobilidade , Parafusos Pediculares , Estudos Retrospectivos , Escoliose/complicações , Fusão Vertebral/instrumentação , Resultado do Tratamento
2.
J Pediatr Orthop ; 40(1): 42-47, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31815861

RESUMO

BACKGROUND: Several authors mentioned surgical outcome for scoliosis associated with neurofibromatosis type 1 (NF-1). However, no studies have summarized long-term surgical outcomes after surgical treatment of early-onset scoliosis (EOS) with NF-1. The purpose of this study is to evaluate the long-term surgical outcome after early definitive spinal fusion for EOS in NF-1 patients. METHODS: We performed a retrospective review on a cohort of 11 patients diagnosed with EOS associated with NF-1 between 1990 and 2009 in our hospital. The study included 7 male and 4 female NF-1 patients with a mean age at fusion surgery of 8 years 4 months who underwent early definitive spinal fusion for EOS. We reviewed radiographs, computed tomography and magnetic resonance images for each patient. The data collected included type of NF-1, Cobb angles, kyphotic angle, spinal length (T1-S1), and pulmonary function. We also evaluated progression of the dystrophic change through radiographs and computed tomography during the follow-up period. RESULTS: The mean follow-up duration was 14 years (5 y 10 mo to 25 y). All patients underwent anterior and posterior fusion surgeries in either 1 or 2 stages. Seven cases had subtotal tumor resection from the concave side followed by rib strut grafting. The mean preoperative Cobb angle of the primary curve was corrected from 71.2 to 24.1 degrees and was maintained at the final follow-up at 23.5 degrees. Mean values for preoperative and final follow-up T1-S1 heights were 30.7 and 36.2 cm, respectively. Mean values for preoperative and final follow-up % forced vital capacity (the present/the predicted) were 75.0% and 74.4%, respectively. The dystrophic change progressed in all cases during the long-term follow-up. CONCLUSIONS: Our goals for NF-1 scoliosis are to obtain deformity correction, to achieve stable instrumentation by using longer fusion levels and to attain a solid fusion mass that can tolerate continual erosion during the long-term follow-up. We achieve this by using a circumferential approach for EOS associated with NF-1. LEVEL OF EVIDENCE: Level IV-case series.


Assuntos
Neurofibromatose 1/complicações , Escoliose/complicações , Escoliose/cirurgia , Fusão Vertebral , Adolescente , Adulto , Criança , Pré-Escolar , Progressão da Doença , Feminino , Seguimentos , Humanos , Cifose/diagnóstico por imagem , Cifose/cirurgia , Imagem por Ressonância Magnética , Masculino , Neurofibromatose 1/cirurgia , Estudos Retrospectivos , Escoliose/diagnóstico por imagem , Escoliose/fisiopatologia , Fusão Vertebral/métodos , Fatores de Tempo , Tomografia por Raios X , Resultado do Tratamento , Capacidade Vital , Adulto Jovem
3.
Isr Med Assoc J ; 21(11): 752-755, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31713365

RESUMO

BACKGROUND: In non-ambulatory patients with cerebral palsy, the presence of scoliosis has a major impact on health and quality of life. The aim of this review is to raise awareness of caregivers from various professions to the extent of the problem, to explain the natural history of neuromuscular scoliosis and its pathophysiology, and to describe up-to-date optional conservative and surgical treatments.


Assuntos
Paralisia Cerebral/complicações , Paralisia Cerebral/fisiopatologia , Escoliose/complicações , Escoliose/fisiopatologia , Pessoas com Deficiência , Humanos , Limitação da Mobilidade , Qualidade de Vida
4.
Medicine (Baltimore) ; 98(38): e17177, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31567958

RESUMO

Lumbar spinal canal stenosis (LSCS) associated with degenerative scoliosis has being increasingly aware by the public and studied by many researchers. Degenerative changes leading to spinal stenosis can precede a spinal deformity which will develop into the de novo scoliosis. There are few studies focusing on the risk factors contributing to the degenerative lumbar scoliosis (DLS) in lumbar spinal stenosis patients.From September, 2017 to December, 2017, 181 patients who were diagnosed with LSCS in the outpatient department of our hospital were enrolled in this retrospective investigation. The patients were divided into 2 groups: DLS group (Cobb angle >10°) and LSCS group. Sex, age, smoking status (yes or no), occupation (heavy or light labor), body mass index (BMI), bone mineral density (BMD) and radiographic parameters including the lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), thoracic kyphosis (TK), coronal vertical axis, and sagittal vertical axis (SVA) are all evaluated as potential risk factors. Multivariate logistic regression analysis and receiver-operating characteristic curves were used to identify potential risk factors.Forty-five of 181 patients were diagnosed with DLS and involved in the DLS group. There were significant differences between the 2 groups in BMI (P < .001), LL (P = .0046), BMD (P < .001), SVA (P < .001), and TK (P = .047). BMD < -1.85 g/cm (adjusted odds ratio [AOR] 0.030, 95% confidence interval [CI] 0.008-0.107, P < .001), BMI >25.57 kg/m (AOR 1.270, 95% CI 1.040-1.551, P = .019), and SVA >3.98 cm (AOR 3.651, 95% CI 2.226-5.990, P < .001) had good accuracy to predict the formation of degenerative lumbar scoliosis based on degenerative lumbar spinal stenosis.Degenerative lumbar scoliosis has a high incidence in degenerative lumbar spinal stenosis. BMD <-1.85 g/cm, BMI >25.57 kg/m, and SVA >3.98 cm were the potential risk factors for the formation of degenerative lumbar scoliosis based on degenerative lumbar spinal stenosis.


Assuntos
Vértebras Lombares , Escoliose/complicações , Estenose Espinal/etiologia , Estudos Transversais , Feminino , Humanos , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Masculino , Pessoa de Meia-Idade , Radiografia , Fatores de Risco , Escoliose/diagnóstico por imagem , Escoliose/patologia , Estenose Espinal/diagnóstico por imagem , Estenose Espinal/patologia
6.
Int J Occup Med Environ Health ; 32(5): 735-745, 2019 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-31588927

RESUMO

Road accidents are among the main fatalities worldwide and drowsy driving is a significant cause of road deaths where drivers are at fault. There are well known diseases which impair sensory and cognitive functions and can cause sleepiness during driving. Such diseases can be an important contraindication to driving because they may have an adverse effect on its safety. Thus, medical examinations for drivers should also be directed at identifying any possible conditions posing risks for driving safety. Occupational medicine specialists should look for symptoms of locomotor and sleep-related breathing disorders as these are medical conditions which could preclude a person from driving. In this case report, the authors describe a professional driver with chest deformity and present a pioneering attempt at assessing his medical fitness to drive. It is also explained why scoliosis can impair driving ability and how it should be diagnosed and treated. Finally, the authors describe how they used driving simulator tests as part of their diagnosis and suggest a relevant treatment regimen. Int J Occup Med Environ Health. 2019;32(5):735-45.


Assuntos
Condução de Veículo , Hipoventilação/terapia , Cifose/complicações , Escoliose/complicações , Adulto , Asma , Simulação por Computador , Humanos , Masculino , Ventilação não Invasiva , Medicina do Trabalho/métodos , Polissonografia
7.
Am J Case Rep ; 20: 1505-1508, 2019 Oct 13.
Artigo em Inglês | MEDLINE | ID: mdl-31606732

RESUMO

BACKGROUND Kyphoscoliosis is an anatomical deformity of the spine often accompanied by an array of respiratory complications, pulmonary hypertension being among the most severe ones. At present, evidence-based treatment options for kyphoscoliosis-related pulmonary hypertension remain limited to the correction of hypoxemia through ventilatory support and long-term oxygenation. CASE REPORT We report a case of a 61-year-old female with severe kyphoscoliosis-related pulmonary hypertension who was admitted to a university hospital in September 2018 due to progressive dyspnea and respiratory failure. She was diagnosed with pulmonary hypertension in 2016 and had been on endothelin receptor antagonist (ambrisentan) and oxygen therapy ever since. Upon admission, the patient presented with severe depression of peripheral oxygen saturation (SpO2 at 75%). The patient declined further treatment hours after hospitalization, despite optimized supportive oxygen therapy. Ambrisentan was discontinued and replaced by inhaled iloprost. Over the course of the next 4 days, the patient showed symptomatic improvement and was discharged on Day 5. Right heart catheterization follow-up in February 2019 showed no worsening in pulmonary hemodynamic parameters compared to the time of initial diagnosis. CONCLUSIONS Managing the respiratory decline in kyphoscoliosis-related pulmonary hypertension can be challenging since these patients tend to deteriorate despite current treatment options. Our case reports on the use of vasoactive agents as a safe and effective treatment option in addition to established therapeutic regimen.


Assuntos
Hipertensão Pulmonar/tratamento farmacológico , Iloprosta/uso terapêutico , Cifose/complicações , Escoliose/complicações , Vasodilatadores/uso terapêutico , Feminino , Humanos , Hipertensão Pulmonar/etiologia , Pessoa de Meia-Idade
8.
Pediatr Surg Int ; 35(11): 1265-1270, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31482324

RESUMO

AIM: With the advancement in the treatment strategies of congenital diaphragmatic hernia (CDH), there is an increase in the survival rates. This fact leads to an increase in the morbidity and extrapulmonary complications in the long term such as failure to thrive, hernia recurrence, neurodevelopmental delay, gastrointestinal problems, and musculoskeletal anomalies. Herein, we aim to investigate the association between the long-term musculoskeletal complications in CDH patients regarding the defect size, repair type, and perinatal parameters. METHODS: After Institutional Review Board approval was obtained (2017-6361), a retrospective chart review was performed on CDH patients from 2003 to 2016. Patients who were operated due to left-sided isolated congenital diaphragmatic hernia and survived to date were included in the study. Data were collected on demographics, preoperative characteristics, operative interventions, and postoperative outcomes. Statistical analysis was performed with IBM SPSS Statistics 20.0.0 (Chicago, IL). RESULTS: There were 98 patients with left CDH of whom 33 (33.7%) had primary repair, 25 (25.5%) had patch repair, and 40 (40.8%) had muscle flap repair. The median age of the patients was 6.00 ± 3.83 years. 45 patients (45.9%) had large diaphragmatic defects, 28 patients (28.6%) had at least one type of musculoskeletal deformities, 2 of which were pectus carinatum, 16 were pectus excavatum, and 18 were scoliosis. CDH patients who had small diaphragmatic defects and repaired with a patch were less likely develop musculoskeletal deformities while who had primary abdominal closure after ventral hernia significantly have more pectus excavatum. CONCLUSION: Although there was a trend towards an increased risk of the pectus deformity and scoliosis in patients repaired with muscle flap, it did not reach statistical significance. There is a correlation between musculoskeletal deformities and the severity of the CDH.


Assuntos
Tórax em Funil/complicações , Hérnias Diafragmáticas Congênitas/complicações , Hérnias Diafragmáticas Congênitas/cirurgia , Pectus Carinatum/complicações , Escoliose/complicações , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Músculo Esquelético/transplante , Estudos Retrospectivos , Telas Cirúrgicas
9.
World Neurosurg ; 131: 154-158, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31398526

RESUMO

BACKGROUND: Proximal junctional failure (PJF) is a major and sometimes devastating problem following adult spinal deformity (ASD) correction surgery. Common consensus still lags on guidelines for preventing and managing these complications. Surgical treatment of scoliosis in the presence of osteogenesis imperfecta (OI) in the pediatric population is well described. The complication rates are unusually higher in this special subset of patients owing to poor quality of bone. There is a paucity of literature focusing on surgical techniques, strategies, and problems involved in the management of ASD associated with OI. CASE DESCRIPTION: We report a 59-year-old female with type 1 OI and adult scoliosis who underwent T10-to-pelvis fusion for ASD according to the principles of adult deformity correction. At a 1-year follow-up, she presented with asymptomatic proximal junctional kyphosis of 45° and 2 weeks later had PJF along with spinal cord injury after a fall. On computed tomography scan, kyphosis was increased to 60° at T9-T10. She underwent decompression and revision deformity correction using quadruple rods, with extension of instrumentation to T2 with soft landing using rib bands. At a 4-year follow-up, she had a good functional outcome after revision surgery. CONCLUSIONS: This is the first report of successful management of PJF following ASD correction in the presence of OI using this technique. Suboptimal hold of implants due to poor bone quality must be at the focus of any surgical planning for these patients. All possible strategies to prevent PJF must be considered when planning the deformity correction in adults with OI.


Assuntos
Cifose/cirurgia , Osteogênese Imperfeita/complicações , Complicações Pós-Operatórias/cirurgia , Escoliose/cirurgia , Descompressão Cirúrgica , Feminino , Humanos , Fixadores Internos , Cifose/diagnóstico por imagem , Cifose/etiologia , Pessoa de Meia-Idade , Osteogênese Imperfeita/diagnóstico por imagem , Osteogênese Imperfeita/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Reoperação , Escoliose/complicações , Escoliose/diagnóstico por imagem , Fusão Vertebral
10.
J Bone Joint Surg Am ; 101(16): 1460-1466, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31436653

RESUMO

BACKGROUND: Posterior spinal fusion with pedicle screws is the gold-standard treatment for adolescent idiopathic scoliosis (AIS); however, it is unclear whether this procedure results in improved long-term back pain and health-related quality of life compared with patients not surgically treated for AIS. The aim of the present study was to evaluate back pain and quality of life in surgically managed patients with a minimum follow-up of 5 years compared with patients with untreated AIS and a healthy control group. METHODS: Fifty-five consecutive adolescent patients who underwent posterior pedicle screw instrumentation for AIS by a single orthopaedic surgeon were prospectively enrolled. At a minimum of 5 years postoperatively, 49 patients completed Scoliosis Research Society (SRS)-24 questionnaires, and data on reoperation were collected. Pain and quality-of-life parameters were compared with those of 49 age and sex-matched patients with untreated AIS and 49 healthy controls. RESULTS: The major curve averaged 53° preoperatively and 12° at 2 years postoperatively. One reoperation (pedicle screw removal) was needed because of a new neurological deficit (transient). The SRS-24 pain, function, and total scores improved significantly from preoperatively to 5 years postoperatively (all p ≤ 0.016), with pain scores improving from 4.0 to 4.3 (p = 0.003). There was no association between pain scores and the preoperative major curve, instrumentation below L1, or postoperative rib hump. The surgical treatment group had significantly better pain, activity, and self-image domain scores at 5 years postoperatively compared with the untreated AIS group (all p ≤ 0.014), and similar pain, self-image, and activity domain scores compared with the healthy control group; function scores were significantly lower in the healthy control group compared with the surgical treatment group (p < 0.001). CONCLUSIONS: Patients who underwent posterior spinal fusion with pedicle screws experienced improved back pain and health-related quality of life compared with patients with untreated AIS. Patients in the surgical treatment group had similar health-related quality of life to that of the healthy control group, except for function, which was significantly lower. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Dor nas Costas/etiologia , Dor Pós-Operatória/fisiopatologia , Qualidade de Vida , Escoliose/cirurgia , Fusão Vertebral/efeitos adversos , Adolescente , Análise de Variância , Dor nas Costas/fisiopatologia , Dor nas Costas/psicologia , Criança , Estudos de Coortes , Feminino , Humanos , Fixadores Internos , Masculino , Análise Multivariada , Medição da Dor , Prognóstico , Valores de Referência , Estudos Retrospectivos , Escoliose/complicações , Escoliose/psicologia , Índice de Gravidade de Doença , Fusão Vertebral/métodos , Resultado do Tratamento , Adulto Jovem
11.
Arkh Patol ; 81(3): 45-50, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31317930

RESUMO

OBJECTIVE: To identify the morphological features of paraspinal muscles in patients with spinal pathology caused by progressive muscular dystrophy. SUBJECT AND METHODS: The Traumatologic-and-Orthopedic Department of Axial Skeleton Pathology examined patients with scoliotic spinal deformity due to muscular dystrophy: 1) severe Duchenne X-linked muscular dystrophy (n=7); 2) Erb-Roth's autosomal recessive muscular dystrophy (n=2); 3) Landouzy-Dejerine facioscapulohumeral muscular dystrophy (n=2). For histopathological analysis of paraspinal muscles, an excisional biopsy was performed in the region of the apex of the strain angle (the convex side), and the specimens were fixed with 10% neutral formalin. Paraffin sections were stained with hematoxylin and eosin according to the Van Gieson and Masson trichrome staining methods. The preparations were examined using an AxioScope.A1 stereo microscope and an AxioCam digital camera ('Carl Zeiss MicroImaging GmbH', Germany). RESULTS: Sluggish moderate paraparesis and grade IV progressive neurogenic thoracolumbar scoliosis were predominant in the clinical picture of the disease. The muscle biopsy specimens were established to have muscle fiber profiles with lost polygonality, increased diameter variability, and centrally positioned or numerous internal nuclei (myophagy) and to be characterized by fiber contractures, fatty degeneration fields, interstitial fibrosis, and signs of axonopathy of intramuscular nerve conductors. The arterial blood vessels were spastic with fibrotic t. media and t. adventicia; the venous bed vessels were dilated, thin-walled, full-blooded, which causes blood corpuscle transudation and numerous hemorrhages. CONCLUSION: The identified morphopathological characteristics of muscle tissue in patients with progressive muscular dystrophy are very similar. However, Duchenne muscular dystrophy is the most severe pathology, in which fatty degeneration and sclerotization of muscle tissue and perimysial vessels are most pronounced. To solve this problem, there is a need for the integration of geneticists, biochemists, molecular biologists, pharmacologists, and histologists.


Assuntos
Músculo Esquelético , Distrofia Muscular Facioescapuloumeral , Escoliose , Biópsia , Fibrose , Humanos , Músculo Esquelético/patologia , Distrofia Muscular Facioescapuloumeral/complicações , Distrofia Muscular Facioescapuloumeral/patologia , Escoliose/complicações
12.
Spine (Phila Pa 1976) ; 44(19): 1396-1402, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31261282

RESUMO

STUDY DESIGN: Retrospective cohort. OBJECTIVE: To determine how respiratory failure rates and duration of intensive care unit (ICU) stay after posterior spinal fusion (PSF) for neuromuscular scoliosis compare between children with Rett syndrome (RS) versus cerebral palsy (CP). SUMMARY OF BACKGROUND DATA: Rett syndrome and CP are associated with high incidence of neuromuscular scoliosis and respiratory dysfunction. METHODS: We included 21 patients with RS (mean age, 13 ±â€Š3.1 yrs) and 124 with CP (mean age, 14 ±â€Š3.2 yrs) who underwent PSF by one surgeon from 2004 to 2017. Preoperative motor function was assessed using the Gross Motor Function Classification System (GMFCS). Primary outcomes were respiratory failure and duration of ICU stay. Secondary outcomes were pneumonia and prolonged use of positive pressure ventilation (PPV). Using multivariate regression, we identified associations of age, intraoperative vital signs, duration of hospital stay, number of vertebral levels fused, anesthesia and surgery durations, and estimated blood loss with longer ICU stay and respiratory failure. RESULTS: A greater proportion of CP patients (96%) than RS patients (66%) were in GMFCS IV or V (P < 0.01). Respiratory failure was more common in RS patients (43% vs. 19%; P = 0.02), as was PPV (67% vs. 31%; P < 0.01). RS patients had shorter median durations of anesthesia and surgery (P < 0.01). RS patients had a longer median (interquartile range) ICU stay (4 days [1-5] vs. 2 days [2-19]; P = 0.01). Incidence of pneumonia did not differ between groups (P = 0.69). Only RS diagnosis (P = 0.02) and prolonged PPV (P < 0.01) were associated with longer ICU stay. CONCLUSION: Despite better preoperative motor function and shorter anesthesia and surgery durations, patients with RS experienced more respiratory failure, prolonged PPV use, and longer ICU stays after PSF than did children with CP. LEVEL OF EVIDENCE: 4.


Assuntos
Paralisia Cerebral , Pneumonia , Complicações Pós-Operatórias/epidemiologia , Síndrome de Rett , Escoliose , Fusão Vertebral , Adolescente , Paralisia Cerebral/complicações , Paralisia Cerebral/epidemiologia , Criança , Humanos , Pneumonia/epidemiologia , Pneumonia/etiologia , Estudos Retrospectivos , Síndrome de Rett/complicações , Síndrome de Rett/epidemiologia , Escoliose/complicações , Escoliose/epidemiologia , Escoliose/cirurgia , Fusão Vertebral/efeitos adversos , Fusão Vertebral/estatística & dados numéricos
13.
Spine (Phila Pa 1976) ; 44(15): 1057-1063, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31335789

RESUMO

STUDY DESIGN: Retrospective clinical study of individuals with osteogenesis imperfecta (OI). OBJECTIVE: To assess the relationship between severity of scoliosis and pulmonary function, and to assess the relationship between restrictive lung disease and self-reported quality of life in individuals with OI. SUMMARY OF BACKGROUND DATA: OI is a heritable connective tissue disorder characterized by osteopenia and a predisposition to fracture. Respiratory insufficiency is a leading cause of mortality. Literature on pulmonary function in this population has shown a negative correlation between percent-predicted vital capacity and severity of scoliosis. However, it has been suggested that decreased pulmonary function in OI may be due to intrinsic pulmonary disease, in addition to the impact of vertebral compression fractures and scoliosis. METHODS: Anterior-posterior spine radiographs and pulmonary function tests from 30 individuals with OI were reviewed. Radiographs were evaluated for scoliosis, defined as a curve ≥ 10°. If more than one curve was present, the largest curve was used. Pulmonary function was defined as the forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) ratio. Restrictive pulmonary disease was defined as FEV1/FVC > 80%, while obstructive disease was defined as FEV1/FVC < 70%. Bivariate correlation analysis was performed, using Spearman rho correlation coefficient (P < 0.05). Quality of life was assessed by SF-36. RESULTS: The mean age was 27.6 years (range: 12-42 yrs). 57.6% were female. OI type IV was the most common (46.7%), followed by OI type III (33.3%), OI type I (10%), OI type IX (6.67% each), and OI type VIII (3.33%). Pulmonary comorbidity was present in 40% of individuals, while 6.67% had a cardiac comorbidity. The correlation between scoliosis and pulmonary function was weak and not significant (R = -0.059, P = 0.747). CONCLUSION: Pulmonary function is not significantly correlated with scoliosis, supporting the hypothesis that decreased pulmonary function is intrinsic to OI and/or chest wall deformities, rather than secondary to scoliosis. LEVEL OF EVIDENCE: 4.


Assuntos
Pneumopatias/etiologia , Osteogênese Imperfeita/complicações , Insuficiência Respiratória/etiologia , Escoliose/complicações , Escoliose/etiologia , Adolescente , Adulto , Criança , Feminino , Fraturas por Compressão/complicações , Humanos , Pulmão/fisiopatologia , Pneumopatias/fisiopatologia , Masculino , Qualidade de Vida , Radiografia , Testes de Função Respiratória , Insuficiência Respiratória/fisiopatologia , Estudos Retrospectivos , Escoliose/diagnóstico por imagem , Fraturas da Coluna Vertebral/complicações , Parede Torácica/fisiopatologia , Capacidade Vital , Adulto Jovem
14.
Pediatr Cardiol ; 40(7): 1468-1475, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31350568

RESUMO

Scoliosis is common in children with congenital heart disease (CHD) and may have deleterious effects on quality of life and hemodynamics. Relatively little is known about the outcomes of spinal fusion for scoliosis repair in children with complex CHD. We reviewed all cases of children with CHD undergoing first time spinal fusion excluding those with minor CHD between 1995 and 2015. Seventy-eight patients were identified and included in the study. 97.4% of patients included had undergone prior cardiac surgery and sixteen patients had single ventricle circulations. 17.9% of patients experienced a significant perioperative event defined as an aggregate of the presence of any of the following: need for early unanticipated reoperation, neurologic deficit, postoperative bleeding requiring intervention, end organ dysfunction, or death. There were no deaths in our cohort. 38.5% of patients experienced any adverse event, the majority of which were related to perioperative fluid shifts. Larger preoperative Cobb angle and longer length of spinal fusion were associated with increased risk of significant perioperative event while larger preoperative Cobb angle and longer length of spinal fusion, older age at time of surgery, single ventricle circulation, cyanosis and patients taking cardiac medications at the time of surgery were more likely to experience any adverse event. Operative repair of scoliosis in children with complex CHD has been performed without mortality over a 20-year period in a single institution, albeit with a higher rate of perioperative complication than is seen in the general pediatric population. Patients with large preoperative Cobb angles and cyanotic single ventricle circulations appear to be at the highest risk for perioperative complications.


Assuntos
Cardiopatias Congênitas/cirurgia , Complicações Pós-Operatórias/epidemiologia , Escoliose/cirurgia , Fusão Vertebral/efeitos adversos , Adolescente , Idoso , Estudos de Casos e Controles , Criança , Feminino , Cardiopatias Congênitas/complicações , Humanos , Masculino , Estudos Retrospectivos , Escoliose/complicações , Fusão Vertebral/estatística & dados numéricos , Resultado do Tratamento
15.
J Pediatr Orthop ; 39(Issue 6, Supplement 1 Suppl 1): S44-S46, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31169647

RESUMO

INTRODUCTION: Adolescent idiopathic Scoliosis (AIS) affects 2% to 3% of the population of which only 0.3% to 0.5% of affected patients will have a curvature of >20 degrees, the curve magnitude at which treatment is generally recommended. For AIS the current natural history data is limited and most of the information comes from a small body of literature from the University of Iowa. METHODS: The Iowa natural history studies began as retrospective reviews but beginning in 1976, the cohort was followed prospectively. Outcomes assessed in this group of patients included; mortality, pulmonary function, pregnancy-(effect of pregnancy on scoliosis and the effect of scoliosis on pregnancy), radiographic, curve progression, and osteoarthritis. In addition, validated questionnaires were used to evaluate back pain, pulmonary symptoms, general function, depression, and body image. RESULTS: Patients with untreated AIS can function well as adults, become employed, get married, have children, and grow to become active older adults. Unfortunately, untreated scoliosis may lead to increased back pain and pulmonary symptoms for patients with large thoracic curves. Patients with untreated AIS can also develop substantial deformity, and the cosmetic aspect of this condition cannot be disregarded. CONCLUSIONS: The summary findings of this unique lifetime natural history of AIS patients provides patients and parents a solid evidence base upon which to make informed decisions.


Assuntos
Dor nas Costas/etiologia , Progressão da Doença , Pulmão/fisiopatologia , Escoliose/complicações , Escoliose/fisiopatologia , Adolescente , Idoso , Imagem Corporal , Criança , Estudos de Coortes , Depressão/etiologia , Humanos , Iowa , Pessoa de Meia-Idade , Escoliose/psicologia , Escoliose/terapia
16.
Medicina (Kaunas) ; 55(6)2019 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-31181685

RESUMO

Background and Objectives: The deformity in idiopathic scoliosis (IS) is three dimensional and effective correction involves all three planes. Recently, the biofeedback method has been implemented in the treatment of scoliosis. The aim of this study was to evaluate the effectiveness of an innovative biofeedback SKOL-AS® postural training among children with scoliosis. Materials and Methods: The target population for this study was 28 patients (25 girls and 3 boys) aged between 5 and 16 years old diagnosed and treated with progressing low-grade scoliosis. The postural diagnosis consisted of anthropometric measurements, posterior-anterior X-ray imaging, SpinalMeter® postural assessment and the angle of trunk rotation (ATR) assessment. The SKOL-AS® treatment comprised of 24 sessions conducted in lying and sitting positions, two times a week. Results: It has been shown that the postural training resulted in the decrease in the ATR value (pre- vs. post-exercise in younger: 5.55 vs. 3.0 and older patients: 5.2 vs. 3.0). The increase in height of the subjects seemed to confirm a positive effect of SKOL-AS® elongation treatment. In the posterior view, a statistically significant decrease in shoulder asymmetry in the sitting position in younger children has been observed. In the anterior view, the changes in the head position (based on mouth and eye symmetry) have been observed. The statistically significant increase in acromion-heel, acromion-iliac crest and posterior superior iliac spine (PSIS)-heel length values has been shown in younger children on the left side of the body. After treatment, older subjects had higher acromion-iliac crest and PSIS-heel values on the left side of the body. On the right side only PSIS-heel length was higher. In a sitting position, only a small increase in acromion-iliac crest length value has been observed. Conclusions: The SKOL-AS® biofeedback method could teach good postural habits and teach patients the auto-correction of the spine.


Assuntos
Biorretroalimentação Psicológica/métodos , Postura/fisiologia , Rotação , Escoliose/terapia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Escoliose/complicações , Escoliose/psicologia
17.
Pain Res Manag ; 2019: 9758273, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30944687

RESUMO

Study design: Retrospective characterization of nonspecific low back pain (NSLBP) in young adult female patients with and without lumbar scoliosis. Background: There is no consensus as to whether NSLBP in scoliosis patients is related to scoliosis per se or is just a normal symptom that could happen in anyone. Objectives: The aim of this study was to compare the differences in NSLBP between young adult female patients with and without lumbar scoliosis and to provide a theoretical basis for differential treatment of NSLBP in patients with and without lumbar scoliosis. Methods: Ninety female young adults with NSLBP were divided into scoliosis and nonscoliosis groups. Characteristics of pain, lumbar mobility, muscle strength, Cobb angle, axial trunk rotation (ATR) angle, and surface electromyography (SEMG) signal were compared between the two groups. Results: The pain location in scoliotic patients was more concentrated on the left side of the lumbar spine (P ≤ 0.001). The area affected by pain (P=0.028) and the numerical pain rating scale (NPRS) scores (P=0.014) of scoliotic patients were less than those of nonscoliotic patients. The difference between side-bending in scoliotic patients was greater than that in nonscoliotic patients (P=0.001). Scoliotic patients exhibited a significantly better ability for flexion (P=0.001) and extension (P=0.017) than nonscoliotic patients. The posterior muscles in scoliotic patients were stronger than those in nonscoliotic patients (P=0.014). The ratio of root-mean-square (RMS) on paraspinal muscles in scoliotic patients was greater than that in nonscoliotic patients (P ≤ 0.001). Scoliotic patients exhibited greater relaxation time during the flexion-relaxation phenomenon (FRP) than nonscoliotic patients (P=0.024). Conclusions: The characteristics of NSLBP experienced by patients with lumbar scoliosis were distinct from those of NSLBP experienced by nonscoliotic patients. The treatment of NSLBP in scoliotic patients should be different from that in nonscoliotic patients.


Assuntos
Dor Lombar/epidemiologia , Dor Lombar/etiologia , Escoliose/complicações , Escoliose/fisiopatologia , Feminino , Humanos , Dor Lombar/fisiopatologia , Vértebras Lombares , Amplitude de Movimento Articular , Estudos Retrospectivos , Adulto Jovem
18.
J Pediatr Orthop B ; 28(4): 393-396, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30932967

RESUMO

This study describes a new procedure for a safer and easier access for the intrathecal injection of the recently approved nusinersen therapy in spinal muscular atrophy. This therapy changed the natural history of the disease, but, to date, scoliosis surgery was an excluding criteria for nusinersen therapy. The bone mass, due to the posterior spinal fusion of the scoliosis surgery, prevents the needle for the nusinersen administration from intervertebral access. This is a single-center, single-surgeon case series descriptive study. A laminotomy at the L3-L4 level was performed to provide safer access for the intrathecal injection. The procedure was carried out during the scoliosis surgery in patients who underwent posterior spinal fusion (PSF) after the nusinersen therapy was introduced, whereas for those who underwent PSF earlier, a second procedure was necessary to perform a laminotomy. A fat grafting was used to prevent bone overgrowth in the laminotomy. Markers were applied as radiographic references for the intrathecal injection. Five patients were enrolled, four females and one male. The mean age of the patients was 11 years. Three patients underwent PSF before the introduction of the nusinersen therapy. Two patients underwent PSF after the nusinersen therapy was available. All of them underwent a laminotomy with a fat grafting at the L3-L4 laminotomy level and received nusinersen therapy without complications. The procedure described is simple and effective in providing safe intrathecal access to make these patients eligible for such important therapy.


Assuntos
Injeções Espinhais/métodos , Vértebras Lombares/cirurgia , Atrofia Muscular Espinal/tratamento farmacológico , Atrofia Muscular Espinal/cirurgia , Escoliose/cirurgia , Fusão Vertebral/métodos , Adolescente , Criança , Feminino , Seguimentos , Humanos , Laminectomia/métodos , Masculino , Atrofia Muscular Espinal/complicações , Oligonucleotídeos/uso terapêutico , Radiografia , Escoliose/complicações , Escoliose/tratamento farmacológico
19.
Medicine (Baltimore) ; 98(15): e15161, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30985695

RESUMO

Adolescent idiopathic scoliosis (AIS) is the most common form of scoliosis, a 3-dimensional deviation in the axis of the spine. Etiology of AIS is unclear and the general belief is that AIS is multifactorial disorder possibly caused by different factors. It would be worthwhile to reveal new factors associated with AIS. The present study aimed to investigate association between sacroiliac joint (SIJ) dysfunction and AIS in young athletes.This case-control study included 196 children athletes (basketball, football, volleyball, handball, ballet, and others), 82 males and 114 females aged 8 to 17, 98 of them with the diagnosis of AIS. The case group consisted of young athletes examined at a regular checkup by a sport physician and diagnosed with AIS. The control group consisted of athletes matched to the case group according to sex, age, sports, number of training years and number of training hours per week, but without AIS.The scoliosis was diagnosed with Adams' forward bend test and the scoliometer measurement. The SIJ dysfunction was determined using the palpation meter (PALM) measuring the sagittal pelvic position in standing position and in standing position with the hip flexion angle of 90°. The data were analyzed using Student t test, Mann-Whitney U test, contingency coefficients, and logistic regression.The average difference in pelvic position in the sagittal plane (in standing position), with and without hip flexion 90° was found to be statistically different in the case and the control groups (t = 13.88, P = .00). There was a strong positive association between variables representing presence of AIS and SIJ dysfunction (determined by contingency coefficient C = 0.62, coefficient Phi = 0.79 and tetrachoric correlation coefficient 0.95).The logistic regression indicated that the average difference in pelvic position in the sagittal plane (in standing position), with and without hip flexion 90° was significantly associated with the probability of scoliosis in young athletes (P = .00, Wald test).There was a strong positive association between SIJ dysfunction and AIS in young athletes.


Assuntos
Artropatias/complicações , Escoliose/complicações , Adolescente , Atletas , Estudos de Casos e Controles , Criança , Feminino , Humanos , Masculino , Articulação Sacroilíaca
20.
World Neurosurg ; 127: e788-e792, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30951919

RESUMO

BACKGROUND: Cervical kyphosis (CK) has been reported in patients with adolescent idiopathic scoliosis (AIS). The report about the incidence of CK between patients with AIS and normal populations was little. Patients included in previous studies often required scoliosis surgery (Cobb angle ≥40°), which does not represent all patients with AIS. The aims of this study were to compare incidence of CK between patients with AIS (Cobb angle >10°) and an age-matched normal population and to identify risk factors related to CK, especially coronal parameters that have rarely been studied in current literature. METHODS: Patients with AIS (n = 112) and asymptomatic subjects from the general population (control group; n = 40) were retrospectively analyzed. Radiographic parameters of coronal and sagittal plane were measured on full-length spine x-rays. Patients with AIS were divided into 2 groups based on cervical lordosis angle: cervical lordosis and CK. RESULTS: CK was observed in 14 of 40 (35%) subjects in the control group and 68 of 112 (60.7%) patients with AIS. Several parameters were related to CK, including major curve, proximal thoracic, and main thoracic Cobb angle; proximal thoracic kyphosis angle; main thoracic kyphosis angle; T1 slope; sagittal vertical axis; vertical distance between C7 plumb line and center sacral vertical line; apical vertebral translation; T1 coronal tilt; and lumbar pelvic relationship. Logistic regression identified main thoracic Cobb angle, main thoracic kyphosis angle, sagittal vertical axis, lumbar pelvic relationship, and apical vertebral translation as independent risk factors of CK. CONCLUSIONS: Incidence of CK increases in patients with AIS relative to normal subjects. Coronal parameters of the spine could influence cervical sagittal alignment.


Assuntos
Vértebras Cervicais/cirurgia , Cifose/cirurgia , Lordose/cirurgia , Escoliose/cirurgia , Adolescente , Feminino , Humanos , Incidência , Cifose/complicações , Cifose/epidemiologia , Vértebras Lombares/cirurgia , Região Lombossacral/cirurgia , Masculino , Fatores de Risco , Escoliose/complicações , Escoliose/epidemiologia , Vértebras Torácicas/cirurgia , Resultado do Tratamento , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA