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1.
BMC Surg ; 21(1): 165, 2021 Mar 25.
Artigo em Inglês | MEDLINE | ID: mdl-33765989

RESUMO

BACKGROUND: Treatment of congenital hemivertebra is challenging and data on long-term follow-up (≥ 5 years) are lacking. This study evaluated the surgical outcomes of posterior thoracolumbar hemivertebra resection and short-segment fusion with pedicle screw fixation for treatment of congenital scoliosis with over 5-year follow-up. METHODS: This study evaluated 27 consecutive patients with congenital scoliosis who underwent posterior thoracolumbar hemivertebra resection and short-segment fusion from January 2007 to January 2015. Segmental scoliosis, total main scoliosis, compensatory cranial curve, compensatory caudal curve, trunk shift, shoulder balance, segmental kyphosis, and sagittal balance were measured on radiographs. Radiographic outcomes and all intraoperative and postoperative complications were recorded. RESULTS: The segmental main curve was 40.35° preoperatively, 11.94° postoperatively, and 13.24° at final follow-up, with an average correction of 65.9%. The total main curve was 43.39° preoperatively, 14.13° postoperatively, and 16.06° at final follow-up, with an average correction of 60.2%. The caudal and cranial compensatory curves were corrected from 15.78° and 13.21° to 3.57° and 6.83° postoperatively and 4.38° and 7.65° at final follow-up, with an average correction of 69.2% and 30.3%, respectively. The segmental kyphosis was corrected from 34.30° to 15.88° postoperatively and 15.12° at final follow-up, with an average correction of 61.9%. A significant correction (p < 0.001) in segmental scoliosis, total main curve, caudal compensatory curves and segmental kyphosis was observed from preoperative to the final follow-up. The correction in the compensatory cranial curve was significant between preoperative and postoperative and 2-year follow-up (p < 0.001), but a statistically significant difference was not observed between the preoperative and final follow-up (p > 0.001). There were two implant migrations, two postoperative curve progressions, five cases of proximal junctional kyphosis, and four cases of adding-on phenomena. CONCLUSION: Posterior thoracolumbar hemivertebra resection after short-segment fusion with pedicle screw fixation in congenital scoliosis is a safe and effective method for treatment and can achieve rigid fixation and deformity correction.


Assuntos
Vértebras Lombares , Escoliose , Fusão Vertebral , Vértebras Torácicas , Seguimentos , Humanos , Vértebras Lombares/cirurgia , Complicações Pós-Operatórias , Escoliose/congênito , Escoliose/cirurgia , Fusão Vertebral/efeitos adversos , Fusão Vertebral/métodos , Vértebras Torácicas/cirurgia , Resultado do Tratamento
2.
Medicine (Baltimore) ; 100(10): e24030, 2021 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-33725816

RESUMO

ABSTRACT: The aim of the study was to determine if multiple intraspinal anomalies increase the risk of scoliosis correction compared to the normal intraspinal condition or 1 or 2 intraspinal anomalies in congenital scoliosis (CS) and whether correction for multiple intraspinal anomalies need to be performed with preliminary neurosurgical intervention before scoliosis correction.A total of 318 consecutive CS patients who underwent corrective surgery without preliminary neurosurgical intervention at a single institution from 2008 to 2016 were retrospectively reviewed, with a minimum of 2 years of follow-up. The patients were divided into 3 groups according to different intraspinal conditions. In the normal group (N group; n = 196), patients did not have intraspinal anomalies. In the abnormal group (A group; n = 93), patients had 1 or 2 intraspinal anomalies. In the multiple anomaly group (M group; n = 29), patients had 3 or more intraspinal anomalies including syringomyelia, split cord malformation [SCM], tethered cord, low conus, intraspinal mass, Chiari malformation or/and arachnoid cyst. The occurrence of complications as well as perioperative and radiographic data were analyzed.The incidence rate of multiple intraspinal anomalies in CS patients was 9.1% (29/318). No significant difference was observed in the perioperative outcomes or radiographic parameters at the final follow-up. There were no significant differences among the 3 groups in the total, major or neurological complication rates (all P > .05). Two patients (1 in the N group and 1 in the A group) experienced transient neurological complications, whereas no patient experienced permanent neurological deficits during surgery or follow-up.To our knowledge, the current study reported the largest cohort of intraspinal anomalies in patients with CS that has been reported in the literature. The results of our study demonstrated that patients with congenital scoliosis associated with intraspinal anomalies, even multiple intraspinal anomalies that coexist with more complex intraspinal pathologies, may safely and effectively achieve scoliosis correction without preliminary neurological intervention. More complex intraspinal pathologies do not seem to increase the risk of neurosurgical complications during corrective surgery.


Assuntos
Anormalidades Múltiplas/cirurgia , Procedimentos Ortopédicos/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Escoliose/cirurgia , Doenças da Medula Espinal/complicações , Medula Espinal/anormalidades , Anormalidades Múltiplas/epidemiologia , Adolescente , Tomada de Decisão Clínica , Feminino , Seguimentos , Humanos , Masculino , Procedimentos Neurocirúrgicos/normas , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Procedimentos Ortopédicos/normas , Procedimentos Ortopédicos/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Escoliose/complicações , Escoliose/congênito , Escoliose/epidemiologia , Medula Espinal/cirurgia , Doenças da Medula Espinal/epidemiologia , Doenças da Medula Espinal/cirurgia , Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
3.
J Pediatr Orthop ; 40(9): e818-e821, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32931689

RESUMO

BACKGROUND: The 6-minute walk test (6MWT) is used to assess the function of cardiopulmonary and neuromuscular conditions in adults and children. The primary research question was to determine the relationship between 6MWT distance and forced vital capacity (FVC) and the major curve among children with congenital scoliosis with rib anomalies. METHODS: The authors recorded 6MWT distance in meters, FVC as a percentage of predicted normal value using arm span for height (FVC%), and Cobb angle in 20 children (13 girls; average age, 6.7±1.3 y) with congenital scoliosis before outpatient surgical treatment. The 6MWT uses a standardized protocol and measures distance traveled in 6 minutes on a flat surface. The authors then determined the correlation between these measures using linear regression analysis. RESULTS: The Cobb angle of the major curvature was 55.4±20.5 degrees. The type of vertebral anomaly was mixed in 17 cases, formation failure in 2 cases, and segmentation failure in 1 case. The range of rib anomalies was 3.4±3.9 levels; 15 and 5 patients, respectively, had unilateral and bilateral rib anomalies. FVC and FVC% were 0.7±0.2 L and 60%±19%, respectively. The ratio of forced expiratory volume at 1 second to FVC (FEV1/FVC), which indicates obstructive lung disease, was normal at 93%±7%. The 6MWT distance was 386.3±59.4 m, which was ≤10% of the predicted distance for normal children. No child was able to walk the normal distance on the basis of published norms. 6MWT distance was significantly correlated with arm span (ρ=0.46, P=0.04) and major curve (ρ=-0.61, P=0.004), but not with FVC% (ρ=0.17, P=0.49). CONCLUSIONS: The 6MWT distance is a feasible measure of function and is substantially reduced before surgery in children with thoracic congenital scoliosis with rib anomalies. The 6MWT distance was significantly correlated with a major curve but not with FVC%. 6MWT distance is not affected by moderate lung function impairment. LEVEL OF EVIDENCE: Level IV-retrospective cohort study.


Assuntos
Escoliose/congênito , Teste de Caminhada , Caminhada/fisiologia , Criança , Pré-Escolar , Feminino , Volume Expiratório Forçado , Humanos , Modelos Lineares , Masculino , Período Pré-Operatório , Radiografia , Estudos Retrospectivos , Escoliose/diagnóstico por imagem , Escoliose/fisiopatologia , Escoliose/cirurgia , Capacidade Vital
4.
World Neurosurg ; 139: e151-e158, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32251829

RESUMO

OBJECTIVE: To evaluate the safety and efficacy of posterior-only surgical correction with heavy halo-femoral traction for the treatment of severe and rigid congenital scoliosis (SRCS) associated with tethered spinal cord (TSC) and type II split cord malformation (SCM). METHODS: Thirteen patients with SRCS associated with TSC and type II SCM underwent posterior-only surgical correction with heavy halo-femoral traction. The preoperative mean coronal Cobb angle was 88.87° ± 12.15°; the mean flexibility was 15.28% ± 3.88%; and the mean angle of thoracic kyphosis and lumbar lordosis was 39.63° ± 18.47° and 56.99° ± 10.02°, respectively. RESULTS: The mean duration of surgery was 320 ± 43.64 minutes and the mean blood loss was 1422.31 ± 457.59 mL. The mean follow-up period was 24.46 ± 7.53 months. After heavy halo-femoral traction, the mean coronal Cobb angle was reduced to 59.14° ± 8.75°. After posterior-only surgical correction, postoperative mean coronal Cobb angle was further reduced to 33.85° ± 8.77°. The postoperative mean correction rate was 62.46% ± 5.04%. The postoperative mean angle of thoracic kyphosis and lumbar lordosis was 29.31° ± 6.75° and 47.79° ± 3.68°, respectively. At the final follow-up, the corrective loss rate of Cobb angle was only 0.69%. There were no significant differences between final follow-up and preoperative modified Japanese Orthopaedic Association total scores. The Scoliosis Research Society-22 total score improved at the final follow-up evaluation compared with the preoperative total score. CONCLUSIONS: Without prophylactic neurosurgical intervention and spine-shortening osteotomy, posterior-only surgical correction with heavy halo-femoral traction could be safe and effective for the treatment of SRCS associated with TSC and type II SCM.


Assuntos
Defeitos do Tubo Neural/complicações , Procedimentos Neurocirúrgicos/métodos , Escoliose/complicações , Escoliose/cirurgia , Tração/métodos , Adolescente , Criança , Feminino , Humanos , Masculino , Escoliose/congênito , Tração/instrumentação
5.
Spine Deform ; 8(4): 809-817, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32170660

RESUMO

STUDY DESIGN: Case reports and review of the literature with a proposed management algorithm. OBJECTIVES: To report two cases of a potential vascular complication due to an incorrectly placed pedicle screw (PS) during spine deformity surgery. Relevant literature regarding the management of vascular complications is reviewed, and an evidence-based management algorithm is proposed. Aortic lesions represent a rare but potentially life-threatening complications with spine deformity and revision surgery, significantly increasing the risk. A management algorithm for an aortic lesion in the case of a malpositioned PS has not yet been published. METHODS: Case 1: An 18-year-old female with proximal thoracic spinal non-instrumented fusion underwent a revision corrective procedure due to a progressive right-sided thoracolumbar compensatory curve. However, postoperative computed tomography (CT) performed to evaluate the position of the PS revealed malposition of the left T9 PS, which was abutting the descending aorta with CT angiography excluding the perforation of the aorta. Case 2: A 17-year-old male was scheduled for correction of Lenke 3-C-N adolescent idiopathic scoliosis. Postoperative routine evaluation with low-dose CT revealed a left T9 PS paravertebral malposition, and subsequent CTA demonstrated that the thread of the PS was in contact with the descending thoracic aorta and an unlikely hemodynamically significant vessel injury. RESULTS: Successful removal of both malpositioned PS was performed. In the first case, a cardiovascular surgeon attended the operation if an urgent thoracotomy was needed, and in the second case, additional video-assisted thoracoscopic control of the aorta was performed during PS removal. CONCLUSIONS: Preoperative imaging in spinal surgery is essential to avoid major vascular and other complications when placing PS, especially in thoracic deformities. When a potential major vessel complication emerges, an interdisciplinary approach and an appropriate management algorithm are mandatory to make the best clinical decisions. LEVEL OF EVIDENCE: 4.


Assuntos
Vértebras Lombares/cirurgia , Parafusos Pediculares/efeitos adversos , Complicações Pós-Operatórias/cirurgia , Escoliose/cirurgia , Fusão Vertebral/efeitos adversos , Fusão Vertebral/instrumentação , Vértebras Torácicas/cirurgia , Adolescente , Algoritmos , Criança , Remoção de Dispositivo/métodos , Feminino , Seguimentos , Humanos , Vértebras Lombares/diagnóstico por imagem , Masculino , Complicações Pós-Operatórias/etiologia , Reoperação , Escoliose/congênito , Escoliose/diagnóstico por imagem , Fusão Vertebral/métodos , Cirurgia Assistida por Computador , Vértebras Torácicas/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Resultado do Tratamento
6.
Spine Deform ; 8(2): 311-316, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32096133

RESUMO

STUDY DESIGN: Retrospective study. OBJECTIVE: The aim of this study was to assess the presence of proximal junctional kyphosis (PJK) in our population of children with early-onset scoliosis (EOS) and to identify the predisposing factors for the development of PJK in the postoperative period after posterior spinal fusion (PSF). Few studies have been conducted to evaluate the incidence of proximal junction kyphosis (PJK) in children after early-onset scoliosis (EOS) after posterior spinal fusion (PSF). MATERIALS AND METHODS: Overall, 114 pediatric patients aged < 10 years who underwent surgery for scoliosis or kyphoscoliosis at a single center between 2013 and 2015 were evaluated. Forty-five patients submitted to PSF of five or more levels met the inclusion criteria. The sample included 12 female and 10 male patients. Mean age at surgery was 7 years and 8 months. RESULTS: PJK was observed in 22 patients (48.9%). Overall, the mean proximal junctional angle at 12 and 36 months was 17.1° and 22°, respectively. The uppermost instrumented vertebra (UIV) with the highest PJK rate was T6-T7. The lowest instrumented vertebra (LIV) with the highest PJK rate was L2. Etiology was idiopathic in 4, neuromuscular in 11, congenital in 14, and syndromic in 16. According to underlying disorder, prevalence of PJK was 78% in those with a congenital, 50% in those with a syndromic, 12% in those with idiopathic, and 9% in those with a neuromuscular EOS. Surgical revision rate was 4% (one patient). Mean postoperative follow-up was of 3 years and 4 months (range 3-4 years and 1 month). CONCLUSION: Congenital and syndromic etiology, but not age at PJK onset or sex of the patient, significantly affected the incidence rate of PJK. The UIV with the highest PJK rate was T6-T7 and the LIV with the highest PJK rate was L2. The patients had a low surgical revision rate. LEVEL OF EVIDENCE: Level IV.


Assuntos
Cifose/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Escoliose/cirurgia , Fusão Vertebral/instrumentação , Fusão Vertebral/métodos , Fatores Etários , Idade de Início , Criança , Pré-Escolar , Feminino , Previsões , Humanos , Lactente , Recém-Nascido , Cifose/etiologia , Vértebras Lombares/cirurgia , Masculino , Complicações Pós-Operatórias/etiologia , Prevalência , Estudos Retrospectivos , Escoliose/congênito , Fusão Vertebral/efeitos adversos , Vértebras Torácicas/cirurgia
7.
Spine Deform ; 8(2): 245-256, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32026445

RESUMO

STUDY DESIGN: Retrospective case series. OBJECTIVE: To elucidate the postoperative course of sagittal alignment in patients with congenital thoracolumbar to lumbar kyphosis or kyphoscoliosis. Acquisition of acceptable sagittal alignment is essential to treat spinal deformity. Little evidence exists regarding long-term surgical outcomes on sagittal alignment in congenital kyphosis or kyphoscoliosis. METHODS: Sixteen consecutive patients (mean age 10.5 ± 3.5 years) with congenital kyphosis or kyphoscoliosis who underwent vertebra resection and osteotomy with instrumentation by single posterior or combined anterior and posterior approach were included. Preoperative radiographs identified kyphosis in 3 patients and kyphoscoliosis in 13 patients. All patients had clinical and radiologic follow-up for > 10 years (mean 16.3 ± 4.0 years). RESULTS: Segmental kyphosis was significantly improved from 33.9° ± 20.1° to 14.9° ± 17.6° by surgery and was finally maintained at 16.8° ± 22.2° and sagittal vertical axis (SVA) of 13.1 ± 33.7 mm at preoperation and 18.3 ± 22.1 mm at postoperation significantly increased to 26.8 ± 45.7 mm during follow-up. Of the 16 patients, 5 (31%) were identified as those with SVA > 40 mm, and SVA increases > 30 mm during follow-up. In patients with sagittal malalignment, radiographs demonstrated decreased lumbar lordosis at the lower foundation from 28.8° ± 39.0° to 17.0° ± 17.6°, significant increased pelvic tilt from 25.8° ± 5.4° to 37.4° ± 7.4° during follow-up (p < 0.05), and larger residual segmental kyphosis than those in the 11 patients without sagittal malalignment with statistical significance. Of the five cases, progression of local kyphosis (one case) and sagittal decompensation, including decreased lumbar lordosis with disc degeneration (four cases), increased pelvic tilt (three cases), or proximal junctional kyphosis (two cases), were observed. CONCLUSION: Based on this > 10-year follow-up study, residual kyphosis and sagittal decompensation are revealed to be risk factors for postoperative sagittal malalignment in patients with congenital thoracolumbar to lumbar kyphosis or kyphoscoliosis. LEVEL OF EVIDENCE: Level IV, case series.


Assuntos
Mau Alinhamento Ósseo/etiologia , Cifose/cirurgia , Vértebras Lombares/cirurgia , Procedimentos Ortopédicos , Osteotomia , Complicações Pós-Operatórias/etiologia , Doença de Scheuermann/cirurgia , Escoliose/cirurgia , Fusão Vertebral/métodos , Vértebras Torácicas/cirurgia , Adolescente , Mau Alinhamento Ósseo/diagnóstico por imagem , Criança , Feminino , Seguimentos , Humanos , Cifose/congênito , Cifose/diagnóstico por imagem , Lordose/diagnóstico por imagem , Lordose/etiologia , Masculino , Complicações Pós-Operatórias/diagnóstico por imagem , Estudos Retrospectivos , Doença de Scheuermann/congênito , Doença de Scheuermann/diagnóstico por imagem , Escoliose/congênito , Escoliose/diagnóstico por imagem , Fatores de Tempo , Resultado do Tratamento
8.
Spine Deform ; 8(4): 733-742, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32109312

RESUMO

STUDY DESIGN: This was a multi-center retrospective cohort study included consecutive pediatric patients who were admitted to 8 institutions for the treatment of congenital spinal deformity from 1991 to 2012. OBJECTIVE: The purpose of this study was to compare curve corrections and balances, reoperations, and complications at 2-year follow-up between those treated early vs. late. Although early intervention has been recommended, no empirical study has examined the optimal timing of short fusion among patients with congenital spinal deformity. METHODS: Patients with congenital spinal deformity with formation failure undergoing vertebrectomy with short fusion (≤ 6 fusion segments) were categorized as early (surgery at ≤ 6 years) and late (7-18 years) fusion. Outcomes included coronal and sagittal curve corrections at immediate and 2-year evaluations; loss of curve correction from immediate to 2-year follow-up; coronal and sagittal balance at 2 years; and inter-operative, major and minor short-term postoperative, and long-term postoperative complications and reoperations. RESULTS: Early fusion (N = 79) compared to late fusion (N = 96) was associated with greater percent curve correction at immediate (71% vs. 60%, p = 0.0046) and 2-year (63% vs. 52%, p = 0.0153) evaluations adjusting for surgeon experience and preoperative coronal balance. These associations were significant for males and those with 3-level fusions but not 4 to 6-level fusions. Early fusion compared with late fusion had more intraoperative (6% vs. 1%) and postoperative long-term complications (27% vs. 18%), as well as unplanned reoperations (13% vs. 9%). Early vs. late fusion had fewer short-term complications, both major (6% vs. 15%) and minor (6% vs. 15%). CONCLUSIONS: Patients who underwent early treatment achieved larger major curve correction by 10% compared to patients with late treatment when assessed at 2-year postoperative evaluation. However, early fusion should be considered with careful attention to possible increased risk of reoperations. LEVEL OF EVIDENCE: Level III.


Assuntos
Escoliose/congênito , Escoliose/cirurgia , Fusão Vertebral/métodos , Coluna Vertebral/cirurgia , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Seguimentos , Humanos , Lactente , Masculino , Estudos Multicêntricos como Assunto , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Equilíbrio Postural , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
9.
Nat Commun ; 11(1): 479, 2020 01 24.
Artigo em Inglês | MEDLINE | ID: mdl-31980602

RESUMO

Congenital scoliosis (CS) is a complex genetic disorder characterized by vertebral malformations. The precise etiology of CS is not fully defined. Here, we identify that mutation in dual serine/threonine and tyrosine protein kinase (dstyk) lead to CS-like vertebral malformations in zebrafish. We demonstrate that the scoliosis in dstyk mutants is related to the wavy and malformed notochord sheath formation and abnormal axial skeleton segmentation due to dysregulated biogenesis of notochord vacuoles and notochord function. Further studies show that DSTYK is located in late endosomal/lysosomal compartments and is involved in the lysosome biogenesis in mammalian cells. Dstyk knockdown inhibits notochord vacuole and lysosome biogenesis through mTORC1-dependent repression of TFEB nuclear translocation. Inhibition of mTORC1 activity can rescue the defect in notochord vacuole biogenesis and scoliosis in dstyk mutants. Together, our findings reveal a key role of DSTYK in notochord vacuole biogenesis, notochord morphogenesis and spine development through mTORC1/TFEB pathway.


Assuntos
Proteína Serina-Treonina Quinases de Interação com Receptores/genética , Escoliose/genética , Proteínas de Peixe-Zebra/genética , Peixe-Zebra/anormalidades , Peixe-Zebra/genética , Transporte Ativo do Núcleo Celular , Animais , Fatores de Transcrição de Zíper de Leucina e Hélice-Alça-Hélix Básicos/metabolismo , Modelos Animais de Doenças , Técnicas de Silenciamento de Genes , Humanos , Modelos Biológicos , Mutação , Notocorda/anormalidades , Notocorda/metabolismo , Notocorda/ultraestrutura , Proteína Serina-Treonina Quinases de Interação com Receptores/antagonistas & inibidores , Proteína Serina-Treonina Quinases de Interação com Receptores/metabolismo , Escoliose/congênito , Escoliose/metabolismo , Transdução de Sinais , Coluna Vertebral/anormalidades , Coluna Vertebral/metabolismo , Fatores de Transcrição/metabolismo , Vacúolos/metabolismo , Peixe-Zebra/metabolismo , Proteínas de Peixe-Zebra/antagonistas & inibidores , Proteínas de Peixe-Zebra/metabolismo
10.
J Pediatr Orthop ; 40(4): e256-e265, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31923019

RESUMO

BACKGROUND: Congenital scoliosis due to hemivertebra of the cervicodorsal spine is a rare disorder. It might be accompanied by impaired cosmetic appearances such as head tilt and trunk shift. Little is known about the effect of correction of the major curve on head tilt and trunk shift in children. The purpose of this study was to assess radiographic changes of head tilt and trunk shift following posterior hemivertebra resection (PHVR). METHODS: Retrospectively, all children who underwent PHVR at the cervicodorsal spine (C6-Th6) with pedicle screw fixation with a minimum radiographic follow-up of 1 year were identified for further assessment. A total of 5 radiographic parameters were assessed on preoperative, postoperative, and final follow-up radiographs. (1) Head tilt was defined as the angle between the horizontal line and the line through both molars of the maxillary, (2) trunk shift as the angle between the line of the center of C7 to the sacrum and the central sacral vertical line, (3) Cobb angle was used to assess the major curve, (4) cranial, and (5) caudal compensatory curvature. RESULTS: Seven boys and 10 girls with a mean age of 9.0 years at surgery were evaluated. The mean radiographic follow-up was 89.5 months (range: 12 to 166 mo). The mean head tilt reoriented from 6.9 to 1.9 degrees (P<0.001); trunk shift improved from 4.3 to 2.5 degrees after surgery (P=0.100). There was a significant correlation between head tilt and trunk shift on preoperative and postoperative radiographs (P=0.030/0.031). The major curve, and compensatory curvatures were all significantly corrected (P<0.001). Head reorientation was significantly influenced by patient age at surgery. Repeated procedures due to decompensation of the compensatory curvature were performed in 2 cases. CONCLUSIONS: PHVR and pedicle screw fixation is an effective treatment for patients with congenital scoliosis. Surgery achieves a significant correction of the major curve and reorientation of the head postoperatively, and till the last follow-up. LEVEL OF EVIDENCE: Level IV.


Assuntos
Anormalidades Musculoesqueléticas , Escoliose , Fusão Vertebral , Criança , Feminino , Alemanha , Humanos , Masculino , Anormalidades Musculoesqueléticas/complicações , Anormalidades Musculoesqueléticas/diagnóstico por imagem , Parafusos Pediculares , Radiografia/métodos , Estudos Retrospectivos , Escoliose/congênito , Escoliose/cirurgia , Fusão Vertebral/instrumentação , Fusão Vertebral/métodos , Resultado do Tratamento
11.
World Neurosurg ; 135: 197-204, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31706972

RESUMO

BACKGROUND: Surgical interventions for congenital scoliosis are challenging for spine surgeons. The coordination of 3-dimensional (3D), real-time, image-guided navigation with an ultrasonic bone cutter allows surgeons to localize the affected area of the spine accurately and remove the lesion without damaging soft tissue structures. The goal of this technical paper is to report a previously undescribed method of hemivertebrectomy that combines 3D, real-time, image-guided navigation and an ultrasonic bone cutter. We highlight the feasibility and safety of this method in spinal surgery. METHODS: Three patients with congenital scoliosis were treated with this technique. We present three illustrative cases comprising hemivertebrectomies for congenital scoliosis. Intraoperative photos demonstrating the technique are also provided. RESULTS: All surgeries were completed without complications. The hemivertebrae were completely removed, and marked correction of congenital scoliosis was noted. CONCLUSIONS: We believe that the combination of 3D, real-time image navigation and an ultrasonic bone cutter improves hemivertebrectomy by increasing accuracy and avoiding dura laceration, major organ damage, or potential vessel damage.


Assuntos
Imageamento Tridimensional/métodos , Vértebras Lombares/cirurgia , Procedimentos Neurocirúrgicos/métodos , Escoliose/cirurgia , Cirurgia Assistida por Computador/métodos , Vértebras Torácicas/cirurgia , Procedimentos Cirúrgicos Ultrassônicos/métodos , Adolescente , Perda Sanguínea Cirúrgica , Criança , Feminino , Humanos , Masculino , Duração da Cirurgia , Parafusos Pediculares , Escoliose/congênito
12.
Adv Ther ; 37(1): 402-419, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31755038

RESUMO

INTRODUCTION: Hemivertebrae excision with local posterior instrumentation is the most common technique for treatment of patients with congenital spine deformity-it is performed at a very young age. We conducted a comparative analysis for accuracy of pedicle screw positioning in infants with congenital scoliosis of the thoracolumbar area inserted using freehand technique in vivo and 3D-printed guiding templates in vitro. METHODS: The study analyzes the results of 10 surgically treated patients with congenital deformity of the thoracolumbar spine due to vertebrae failure of formation. These patients were included in group 1 (in vivo) comprising six boys and four girls with a mean age of 3 years 8 months (2 years 2 months-6 years 8 month). Group 2 (in vitro) consisted of 27 plastic 3D-printed models of congenitally deformed spine of the same 10 patients in which screws were placed using 3D-printed guiding templates. The accuracy of screw position was assessed using computer tomography data performed postoperatively with Gertzbein-Robbins classification. RESULTS: Results of our study show that screw insertion using 3D-printed guiding templates during surgical treatment of infants with congenital spine deformities is more accurate than using freehand technique (96.3% vs. 78.8% p = 0.011). CONCLUSION: The data show that this method of screw insertion is very promising and can be used in surgical treatment of infants with congenital spine deformities.


Assuntos
Parafusos Pediculares , Impressão Tridimensional , Procedimentos Cirúrgicos Reconstrutivos/métodos , Escoliose/congênito , Escoliose/cirurgia , Tomografia Computadorizada por Raios X/métodos , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Lactente , Masculino , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento
13.
J Pediatr Orthop ; 40(3): e182-e185, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31157754

RESUMO

BACKGROUND: The 24-item Early-Onset Scoliosis Questionnaire (EOSQ-24) and 22-item Scoliosis Research Society (SRS-22) questionnaire measure health-related quality of life in patients with scoliosis. The EOSQ-24 has been recently validated in early-onset scoliosis (EOS), including congenital scoliosis (CS). The SRS-22 has been validated in idiopathic scoliosis. The EOSQ-24 is completed by the caregiver and the SRS-22 is completed by the patient. The primary purpose of this study was to compare the EOSQ-24 and SRS-22 in patients with CS. The secondary purpose was to compare scores by age and also in developmentally delayed patients. We hypothesized that the SRS-22 is appropriate for children with EOS from CS who do not have a diagnosis of developmental delay. METHODS: This was a prospective comparative study. A prospective institutional CS database was queried to identify patients who had the EOSQ-24 and SRS-22 completed at the same time point. Children without a diagnosis of developmental delay completed both questionnaires if they understood the questions, regardless of age. Otherwise, the caregiver completed both questionnaires. For the analysis, similar questions were matched so that the EOSQ-24 questions fit into the SRS-22 domains of Function, Pain, Mental Health, and Satisfaction. Pearson correlation coefficients (r) were used to compare domain scores, with r≥0.70 indicating a strong relationship. RESULTS: The final study group included 98 patients. The average age at completion of the questionnaires was 9.5 years. A strong correlation was found for all domains except Satisfaction when the patient or caregiver completed both questionnaires. Subanalysis demonstrated the strongest relationship between domains in the age group 0 to 5 years. In developmentally delayed patients, a weak correlation was noted for all domain scores except Pain, which showed a strong correlation. There was a strong correlation for Pain and a weak correlation for Satisfaction domains across all subgroups. CONCLUSIONS: The SRS-22 may be appropriate for children with EOS from CS who do not have a diagnosis of developmental delay. Our findings suggest that the results of previous studies that collected the SRS-22 and future studies that collect the EOSQ-24 can be correlated. It remains unclear which questionnaire is more suitable for developmentally delayed patients. LEVEL OF EVIDENCE: Level I-diagnostic.


Assuntos
Qualidade de Vida , Escoliose , Inquéritos e Questionários , Criança , Deficiências do Desenvolvimento/diagnóstico , Feminino , Humanos , Masculino , Medição da Dor , Desempenho Físico Funcional , Estudos Prospectivos , Reprodutibilidade dos Testes , Projetos de Pesquisa , Escoliose/congênito , Escoliose/diagnóstico , Escoliose/psicologia
15.
J Pediatr Orthop ; 39(10): 495-499, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31599857

RESUMO

BACKGROUND: Congenital spinal deformity (CSD) has traditionally been treated with 3-column osteotomies [hemivertebrectomy (HV) or vertebral column resection (VCR)] to address rigid deformities. Alternatively, multiple Ponte osteotomies (PO) may provide correction while minimizing risk. The purpose of this study was to compare safety and outcomes of patients undergoing surgical treatment for CSD with these 3 procedures. METHODS: Retrospective review of CSD patients treated with posterior spinal fusion between 1996 to 2013. Patients treated with multiple Ponte osteotomies (PO group) were compared with those managed with 3-column osteotomies (HV/VCR group). Patients with previous instrumentation, isolated cervical deformity, growing spine instrumentation, or <2 year follow-up were excluded. Deformity angular ratio (DAR) was calculated as curve magnitude divided by number of levels of the deformity. RESULTS: There were 49 patients [17 PO, 32 HV/VCR (26 HV, 6 VCR)]. For the PO group, mean age was 14 years, and they had an average of 4 ponte osteotomies and 11 levels fused. Mean total DAR was 25 and mean number of congenital anomalies was 1.8 in the PO group. The HV/VCR group had a mean age of 7 years and 5 levels fused. Mean total DAR was 28 and mean number of congenital anomalies was 2.1 in the HV/VCR group. Patients had a mean of 54.1% correction of coronal deformity in the PO group and 54.4% in the HV/VCR group (P=0.78). Signal changes were observed less frequently with PO (1/17) and HV (1/26) than with VCR (4/6), P=0.001. Revision rates were 17.6% (3/17) in the PO group and 37.5% (12/32) in the HV/VCR group (P=0.35). CONCLUSIONS: Patients with CSD and a mean total DAR of 25 treated with multiple PO and long fusions had correction comparable with the HV/VCR group. Patients treated with VCR had the highest incidence of signal changes and postoperative neurologic deficits. LEVEL OF EVIDENCE: Level III.


Assuntos
Cifose/cirurgia , Osteotomia/métodos , Escoliose/cirurgia , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Cifose/congênito , Masculino , Osteotomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Escoliose/congênito , Fusão Vertebral , Coluna Vertebral/cirurgia , Resultado do Tratamento
16.
J Pediatr Orthop ; 39(9): 487-494, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31503238

RESUMO

BACKGROUND: Though computed tomography (CT) and 3 dimensional (3D) reconstruction of the spine and ribcage are powerful techniques for detailed monitoring of spinal growth and surgical planning of patients, drawbacks can arise. We explored the application of low-dose stereoradiography of the spine to calculate distinct morphologic parameters of the vertebral body in a juvenile patient population with early-onset scoliosis or congenital scoliosis. This study compares the 3D vertebral morphology measurements using low-dose stereoradiography with the currently accepted imaging modality for such measurements, CT scans. METHODS: A total of 86 vertebrae of 6 patients with early-onset scoliosis and 3 patients with congenital scoliosis, age ranged between 7.8 and 12.5 years, who had both thoracic spine CT scan and low-dose stereoradiography of the spine were included. 3D reconstructions of CT and low-dose stereoradiography were generated. Using previously validated image processing techniques, vertebral anterior (A), posterior (P), left (L), and right (R) heights, superior and inferior endplates depth and width (S-D, I-D, S-W, I-W) were measured on the CTs' 3D reconstructions and were compared with the same parameters measured on low-dose stereoradiography reconstructions using a postprocessing custom code. The agreement between the 2 techniques in measurement of the vertebral morphology was assessed using the Bland-Altman plots. RESULTS: No significant difference was observed in the A, P, L, R, S-W, and I-W between the stereoradiography and CT measurements (P>0.05). S-D and I-D were significantly greater in low-dose stereoradiography measurements P<0.05. Bland-Altman plots showed an agreement between the stereoradiography and CT techniques in vertebral height measurements (A, P, L, R); however, larger measurement bias and greater limits of agreement in S-D, I-D, S-W, and I-W measurements were shown. CONCLUSIONS: In vivo measurements of the vertebral heights using low-dose stereoradiography 3D reconstructions were comparable with CT measurements except for the superior and inferior vertebral depths. The low-dose stereoradiography imaging modality and the postprocessing platform can be used for assessment of the vertebral heights and monitoring asymmetric growth in patients undergoing growth-sparing treatment except for the vertebral levels with congenital deformities. LEVEL OF EVIDENCE: Level IV.


Assuntos
Imageamento Tridimensional/métodos , Vértebras Lombares/diagnóstico por imagem , Escoliose/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adolescente , Criança , Humanos , Doses de Radiação , Escoliose/congênito
17.
J Pediatr Orthop ; 39(8): 406-410, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31393299

RESUMO

BACKGROUND: Congenital scoliosis (CS) is associated with more rigid, complex deformities relative to adolescent idiopathic scoliosis (AIS) which theoretically increases surgical complications. Despite extensive literature studying AIS patients, few studies have been performed on CS patients. The purpose of this study was to evaluate complications associated with spinal fusions for CS and AIS. METHODS: A retrospective review of the Kid's Inpatient Database (KID) years 2000 to 2009 was performed. Inclusion: patients under 20 years with ICD-9 diagnosis codes for idiopathic scoliosis (IS-without concomitant congenital anomalies) and CS, undergoing spinal fusion from the KID years 2000 to 2009. Two analyses were performed according to age below 10 years and 10 years and above. Univariate analysis described differences in demographics, comorbidities, intraoperative complications, and clinical values between groups. Binary logistic regression controlling for age, sex, race, and invasiveness predicted complications risk in CS (odds ratios; 95% confidence interval). RESULTS: In total, 25,131 patients included (IS, n=22443; CS, n=2688). For patients under age 10, CS patients underwent 1 level shorter fusions (P<0.001), had fewer comorbidities (P<0.001), and sustained similar complication incidence. In the 10 and over age analysis, CS patients similarly had shorter fusions, but greater comorbidities, and significantly more complications (odds ratio, 1.6; confidence interval, 1.4-1.8). CONCLUSIONS: CS patients have higher in-hospital complication rates. With more comorbidities, these patients have increased risk of sustaining procedure-related complications such as shock, infection, and Adult Respiratory Distress Syndrome. These data help to counsel patients and their families before spinal fusion. LEVEL OF EVIDENCE: Level III-retrospective review of a prospectively collected database.


Assuntos
Complicações Pós-Operatórias , Escoliose , Fusão Vertebral , Adolescente , Criança , Comorbidade , Bases de Dados Factuais , Feminino , Humanos , Incidência , Pacientes Internados/estatística & dados numéricos , Masculino , Complicações Pós-Operatórias/classificação , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Escoliose/congênito , Escoliose/cirurgia , Fusão Vertebral/efeitos adversos , Fusão Vertebral/métodos , Fusão Vertebral/estatística & dados numéricos , Estados Unidos/epidemiologia
18.
J Bone Joint Surg Am ; 101(15): 1357-1365, 2019 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-31393426

RESUMO

BACKGROUND: There have been many reports on the treatment of congenital kyphoscoliosis. However, congenital deformities in the cervicothoracic spine (C7-T1) have not been well described because of the rarity of these conditions. METHODS: The medical records and imaging studies of 25 children who were treated with 360° osteotomy for congenital deformities in the cervicothoracic spine (C7-T1) at a mean age of 11.4 years were reviewed. RESULTS: All 25 children presented with torticollis; 4 presented with neck pain; 10, with facial asymmetry; and 3, with preoperative neurological deficits. Twenty-three patients had congenital deformities in other regions of the spine. Six patients had a total of 8 intraspinal deformities. On average, the cervicothoracic curve was corrected from 53° preoperatively to 14° at the latest follow-up, the segmental kyphosis was corrected from 25° to 12°, and the head tilt improved from 25° to 5°. Nineteen patients had a total of 28 complications, including 1 transient cord injury together with a permanent C8 nerve root injury, 11 transient nerve root injuries, 1 transient Horner syndrome, 9 cases of decompensation of a compensatory curve, 2 implant failures, 2 cases of hemothorax, 1 dural tear, and 1 case of delayed wound-healing. CONCLUSIONS: Most congenital cervicothoracic deformities are fixed, and early surgical intervention may be needed. A 360° osteotomy is indicated for this type of rigid deformity and may provide satisfactory correction. However, 360° osteotomy in the cervicothoracic spine (C7-T1) is technically demanding with a higher risk of nerve root injuries, although most injuries tend to be transient. If the compensatory thoracic curve is severe and rigid, 1-stage or staged surgery in this region may be required. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Cifose/cirurgia , Osteotomia/métodos , Amplitude de Movimento Articular/fisiologia , Escoliose/cirurgia , Tomografia Computadorizada por Raios X/métodos , Adolescente , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Criança , Estudos de Coortes , Anormalidades Congênitas/diagnóstico por imagem , Anormalidades Congênitas/cirurgia , Bases de Dados Factuais , Feminino , Humanos , Cifose/congênito , Cifose/diagnóstico por imagem , Masculino , Duração da Cirurgia , Osteotomia/efeitos adversos , Posicionamento do Paciente , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Cuidados Pré-Operatórios/métodos , Prognóstico , Recuperação de Função Fisiológica , Estudos Retrospectivos , Medição de Risco , Escoliose/congênito , Escoliose/diagnóstico por imagem , Vértebras Torácicas/diagnóstico por imagem , Vértebras Torácicas/cirurgia , Torcicolo/diagnóstico , Torcicolo/etiologia , Torcicolo/cirurgia
19.
J Med Life ; 12(2): 192-193, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31406523

RESUMO

This paper presented a special case and shortly described the congenital malformations of a child operated at the age of 2 years and 7 months. Medical literature does not mention the cases of double or triple congenital scoliosis. 54 patients were treated, out of whom, 39 were operated during the period of 2000 and 2012. This series presented 4 patients with double congenital scoliosis and 2 with triple congenital scoliosis. All these axial deviations were due to hemivertebrae with longitudinal imbalance of the spine, if these hemivertebrae were present on a distance of at least 5 normal vertebrae.


Assuntos
Escoliose/congênito , Escoliose/cirurgia , Coluna Vertebral/cirurgia , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Imagem por Ressonância Magnética , Masculino , Cuidados Pós-Operatórios , Escoliose/diagnóstico por imagem , Coluna Vertebral/diagnóstico por imagem , Tomografia Computadorizada por Raios X
20.
Ethiop J Health Sci ; 29(3): 413-416, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31447511

RESUMO

Background: Lumbo-costo-vertebral syndrome is a set of rare abnormalities involving vertebral bodies, ribs, and abdominal wall. Case: We present a case of Lumbo-costo-vertebral syndrome in a 6-month old female infant who had a progressive swelling over the right lumbar area since birth. Clinical examination revealed a reducible swelling on the right flank with positive cough impulse. Ultrasonography showed a defect containing bowel loops in the right lumbar region. Chest X-ray revealed scoliosis and hemivertebrae with absent lower ribs on the right side. Computer tomography scan showed hernia sac containing the bowel and the right lobe of the liver with cross fused kidney. Conclusion: Lumbo-costo-vertebraly syndrome is a rare condtion which could be associated with different organ malformations. Simple closure or meshplasty could be done depending on the size of the defect.


Assuntos
Anormalidades Múltiplas/patologia , Hérnia Abdominal/congênito , Vértebras Lombares/anormalidades , Costelas/anormalidades , Parede Abdominal/anormalidades , Feminino , Humanos , Lactente , Escoliose/congênito , Síndrome
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