European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
-
Congenital lordoscoliosis is an uncommon pathology and its management poses formidable challenge especially in the presence of type 2 respiratory failure and intraspinal anomalies. In such patients standard management protocols are not applicable and may require multistage procedure to minimize risk and optimize results. ⋯ The management of severe and rigid congenital lordoscoliotic deformities with intraspinal anomalies is challenging. Progressive reduction in respiratory volume in untreated cases can lead to acute respiratory failure. Such patients have a high rate of intraoperative and postoperative morbidity and mortality. Hence a staged procedure is recommended. Initially a less invasive procedure like halo traction helps to improve their respiratory function with simultaneous correction of the deformity, while allowing for monitoring of neurological deficit. Subsequently spinal osteotomies and combined halo traction helps further improve the correction, following which definitive instrumented fusion can be done.
-
The main treatment for congenital scoliosis is posterior hemivertebra resection with bilateral transpedicular fixation. Reports describing posterior unilateral intervertebral fusion and transpedicular screw fixation are rare, with no long-term follow-up results, especially in older children. Retrospective analysis of the long-term outcomes of unilateral fusion and fixation after hemivertebra resection for congenital scoliosis. ⋯ Unilateral transpedicular screw fixation provides satisfactory correction of the spinal deformity in both very young and older children. Unilateral intervertebral fusion and transpedicular fixation represents an advisable alternative method for the correction of congenital scoliosis and has advantages of reduced trauma, less surgery time and lower expense. Furthermore, the non-fused concave side offers the opportunity for correction of subsequent spine deformity.
-
Although adolescent idiopathic scoliosis (AIS) is known to impact the 3D orientation of the spine and pelvis, the impact of the vertebral position relative to the X-ray scanner on the agreement between 2D and 3D measurements of a curve has not been evaluated. The purpose of this study was to investigate the agreement between 2D and 3D measurements of the scoliotic curve as a function of the 3D spinal parameters in AIS. ⋯ Clinically and statistically significant differences were observed between the 2D and 3D measurements of the scoliotic spine. The differences between the 2D and 3D techniques were significant in sagittal plane and were related to the spinal curve and pelvic rotation in transverse plane.
-
Case Reports
The management of high-grade spondylolisthesis and co-existent late-onset idiopathic scoliosis.
It is relatively common for a scoliosis deformity to be associated with a lumbar spondylolisthesis in adolescents (up to 48 % of spondylolistheses). In the literature two types of curve have been described: 'sciatic' or 'olisthetic'. However, there is no consensus in the literature on how best to treat these deformities. Some authors advocate a single surgical intervention, where both deformities are corrected; whereas, others advocate treating them as separate entities. In this situation, it has been shown that the scoliosis will correct with treatment of the spondylolisthesis. ⋯ There are no standard guidelines and therefore, we discuss the management of this difficult problem, exemplifying a case of a young girl who had high-grade spondylolisthesis along with a clinically non-flexible scoliosis treated at our institution. We demonstrate that it is safe to observe the scoliosis, even in high-grade spondylolistheses.
-
To investigate surgical outcomes and complications of scoliosis associated with Marfan syndrome. ⋯ In conclusion, as compared to anterior release combined with posterior spinal fusion, posterior-only spinal fusion could yield comparable clinical outcomes for scoliosis associated with Marfan syndrome with lower EBL, and operation time. However, longer follow-up is needed to verify these findings.