Perioperative complications after surgical correction in neuromuscular scoliosis

PURPOSE: To evaluate the perioperative complications associated with surgical correction in neuromuscular scoliosis and to identify the risk factors associated with these complications. METHODS: A retrospective review of the hospital charts of patients with neuromuscular scoliosis who underwent surgical correction at a medical center was performed. RESULTS: Data was available on a total of 175 patients. The overall perioperative complication rate was 33.1% (96 complications in 58 patients). Complications were subdivided into pulmonary issues (19.4%), wound and implant infections (9.7%), cardiovascular complications (4.0%), intraoperative neurological changes (4.6%), miscellaneous complications (5.7%), and problematic instrumentation (3.4%). No patient had an identifiable permanent postoperative change in neurological status. The complication rate in patients who underwent single-stage procedures (37.4%) was found lower than that in patients who underwent staged procedures (57.1%). There were no deaths during the perioperative period. CONCLUSIONS: Patients with neuromuscular scoliosis are at high risk of developing perioperative complications after surgical correction of their deformity (overall rate, 33.1%).     

伴颈椎过伸的强直性脊柱炎脊柱后凸畸形1例报道

<正>强直性脊柱炎(ankylosing spondylitis,AS)主要累及中轴骨及关节,常从骶髂关节向头侧逐渐进展,晚期常易出现胸腰段后凸畸形。部分AS患者常常累及整个脊柱的强直,包括颈椎、胸椎、腰椎的强直,严重影响患者生活质量。颈椎畸形多为颈椎后凸畸形,如颌-胸畸形(chin-onchest deformity),而颈椎过伸畸形相对较为少见,畸形不严重者多无需外科干预。我们在临床中可以遇到某些极特殊的病例,胸腰段后凸畸形很大,但颌眉角(chin-brow vertical angle,CBVA)增大幅度不大,甚至仍然在正常范     

Lengthening of the lower limbs and correction of lumbar hyperlordosis in achondroplasia

The analysis of more than 500 elongations carried out over a period of 15 years has led to the development of a technique of elongation of limbs in which surgical trauma and operative risk have been reduced to a minimum since all of the surgical stages are performed percutaneously. This technique results in overall elongations of more than 30 cm in the lower limbs, which makes it highly effective in the correction of short stature (achondroplasia, osteochondrodysplasia, hypopituitarism, Turner's syndrome) and severe limb length discrepancy. The techniques are used for elongating tibiae and femora as well as the modifications required to decrease lumbar hyperlordosis after lengthening of the femur. A review of the results and complications of the latest series treated with this technique consists of 208 tibiae and 156 femura.     

Lipoblastoma: pathophysiology and surgical management

BACKGROUND/PURPOSE: Lipoblastoma/lipoblastomatosis is a poorly understood and uncommon soft tissue tumor of infancy and early childhood. Twenty-four patients that presented to a single institution over a 15-year period were reviewed for clinical features and outcome. METHODS: A retrospective review was conducted. RESULTS: Twenty-five cases were identified; 1 chart was not available for review. Fourteen girls and 11 boys with a median age of 20 months (2 months, 10 years) presented with 26 separate tumors. Nineteen were focal and 7 diffuse. The tumors were located on the trunk (n = 13), leg (n = 6), arm (n = 3), and head and neck (n = 4). Five patients (all with diffuse type) had up to 3 recurrences. CONCLUSIONS: Patients with focal lipoblastoma are unlikely to require further surgery after initial resection. Patients with diffuse lipoblastoma (lipoblastomatosis) are likely to have recurrent disease (usually within 2 years) and should undergo close follow-up. Genetic analysis of the specimen will help exclude liposarcoma. Recurrent lesions are best imaged with magnetic resonance imaging to assess extent and plan reconstruction if necessary.     

Aortic origin of right pulmonary artery: successful surgical correction in three consecutive patients

Over a period of four years (1981 through 1984), 3 infants with aortic origin of the right pulmonary artery were seen in our surgical unit. Two infants had a persistent ductus arteriosus, which arose from the left subclavian artery in 1 of them who also had a right-sided aortic arch. There were no other associated abnormalities. Preoperative diagnosis was established by echocardiography in 2 infants. Anatomical surgical correction was undertaken in all 3 infants under cardiopulmonary bypass. There were no operative deaths. One child required reoperation at 15 months for anastomotic stenosis. All 3 children were well two to five years postoperatively with scintillographic evidence of normal ventilation and perfusion. Our experience indicates that this rare but severe congenital cardiac anomaly is easily diagnosed by echocardiography, and confirms that it is eminently amenable to surgical correction.     

A new pelvic rod system for the surgical correction and fixation of pelvic obliquity in pediatric neuromuscular scoliosis

Purpose  

To describe surgical outcomes using the new device in pediatric neuromuscular scoliosis.     

Lumbar spinal stenosis: surgical considerations

Spinal stenosis is an acquired or congenital narrowing of the spinal or nerve-root canals. Surgical treatment is often effective. Acquired spinal stenosis most commonly occurs in those with degenerative disk disease and arthritic facets. If the degenerative process stabilizes and there is adequate room to accommodate the neural contents, symptomatic patients become asymptomatic. Residual stability after decompression must be assessed in patients having multilevel decompression. Fusion maybe indicated. In women with osteoporosis coexisting with degenerative scoliosis and spinal stenosis, decompression for concave nerve-root compression and fusion are necessary. Spinal fusion is not indicated in patients with lumbar spinal stenosis having unilateral decompression for lateral stenosis. Patients with central-mixed stenosis may not need fusion. Patients with spinal stenosis after laminectomies and diskectomies had better results when arthrodesis was done in conjunction with repeated decompression. Arthrodesis with instrumentation and decompression is recommended for patients with degenerative spondylolisthesis.     

Lumbar pedicle: surgical anatomic evaluation and relationships

Although several clinical applications of transpedicular screw fixation in the lumbar spine have been documented for many years, few anatomic studies concerning the lumbar pedicle and adjacent neural structures have been published. The lumbar pedicle and its relationships to adjacent neural structures were investigated through an anatomic study. Our objective is to highlight important considerations in performing transpedicular screw fixation in the lumbar spine. Twenty cadavers were used for observation of the lumbar pedicle and its relations. After removal of whole posterior bony elements including spinous processes, laminae, lateral masses, and inferior and superior facets, the isthmus of the pedicle was exposed. Pedicle width and height (PW and PH), interpedicular distance (IPD), pedicle-inferior nerve root distance (PIRD), pedicle-superior nerve root distance (PSRD), pedicle-dural sac distance (PDSD), root exit angle (REA), and nerve root diameter (NRD) were measured. The results indicated that the average distance from the lumbar pedicle to the adjacent nerve roots superiorly, inferiorly and to the dural sac medially at all levels ranged from 2.9 to 6.2 mm, 0.8 to 2.8 mm, and 0.9 to 2.1 mm, respectively. The mean PH and PW at L1-L5 ranged from 10.4 to 18.2 mm and 5.9 to 23.8 mm, respectively. The IPD gradually increased from L1 to L5. The mean REA increased consistently from 35 degrees to 39 degrees. The NRD was between 3.3 and 3.9 mm. Levels of significance were shown for the P < 0.05 and P < 0.01 levels. On the basis of this study, we can say that improper placement of the pedicle screw medially and inferiorly should be avoided.     

Variants of sagittal synostosis: strategies for surgical correction

Sagittal synostosis is discussed with respect to the variations seen with the deformity. The morphological spectrum ranging from marked frontal bossing to prominent occipital bulging is described. Surgical techniques have been specifically designed for these variants. These techniques provide an immediate correction of scaphocephaly, and achieve a reduction of the specific deformity with morbidity comparable to that associated with conventional operations. The lack of large areas of craniectomy and the avoidance of synthetic materials are cited as additional advantages of these techniques. The importance of altering the surgical approach to the specific clinical problem is underscored. Two illustrative cases of sagittal synostosis variants are described, and recent experience with the modified operative techniques in treating these and similar cases is discussed.     

Anomalous aortic origin of the right coronary artery: An unusual cause of angina pectoris and its surgical correction

A 45-year-old female presented with typical recent-onset exertional angina pectoris. Subsequent investigation showed that the likely cause was an aberrant origin of the right coronary artery arising from the left coronary sinus. This anomaly is uncommon and is not usually associated with angina pectoris. Surgical rerouting of the origin of the right coronary artery produced complete resolution of ischaemia.     

Megalourethra: surgical technique for correction of an unusual variant

We report a case of an unusual variant of megalourethra associated with urethral duplication. The surgical technique for an enlarged and massively deformed phallus is described.     

Brachymetapody: case report of surgical correction

Brachymetapody is an uncommon condition that can have both cosmetic and functional considerations. The literature is reviewed with respect to techniques for repair of short metatarsals. Surgical indications are discussed as well as techniques for repair. A case report of bilateral first and fourth metatarsal brachymetapody is reviewed with illustration of a successful surgical outcome after more than 5 years of follow-up.