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Michaeli A, Miller S, Danto J, Arzi H, Schroeder JE, Ovadia D. Characteristics and Usefulness of Neurophysiological Monitoring in Corrective Procedures for Abnormally Curved Spine in Young Patients. J Clin Neurophysiol 2024:00004691-990000000-00134. [PMID: 38857370 DOI: 10.1097/wnp.0000000000001074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024] Open
Abstract
PURPOSE To identify and characterize events of deterioration in intraoperative neuromonitoring data during correction procedures for thoracic and lumbar abnormal spinal curvature in young patients. METHODS Records of 1,127 cases were retrospectively reviewed to identify events with deterioration of the neuromonitoring data. General etiological and demographic variables were summarized, and neuromonitoring events were studied and characterized. RESULTS Adolescent idiopathic cases were associated with female dominance and older age. Nonadolescent idiopathic cases were associated with a higher rate of neuromonitoring events. The neuromonitoring events evolved during the different procedural stages, were primarily reflected in the motor-evoked potential data and affected a range of neural structures to varying degrees. Most of the events were resolved, partially or completely, following a corresponding intervention by the surgical team, before the end of the procedure. Significant immediate weakness of the lower extremities was demonstrated in patients with unresolved neuromonitoring events, most of them were nonadolescent idiopathic patients. CONCLUSIONS Neurophysiological monitoring enables the intraoperative assessment of the integrity of neural pathways and allows the detection of surgery-related impending neural injuries. Neuromonitoring contributes to intraoperative decision making, either when data are uneventful and allow confident continuation or when data deteriorate and lead to corresponding intervention. Further awareness should be paid to the vulnerable characteristics of the patient, surgery course, and neuromonitoring data. Proper interpretation of the neuromonitoring data, together with corresponding intervention by the surgeon when necessary, has the potential to reduce postoperative neurological insults and improve clinical outcomes.
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Affiliation(s)
| | - Sara Miller
- Surgical Monitoring Services LTD, Beit Shemesh, Israel
- Department of Pediatric Orthopedics, Dana Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Joseph Danto
- Surgical Monitoring Services LTD, Beit Shemesh, Israel
| | - Harel Arzi
- Department of Orthopedics, Shaare Zedek Medical Center, Jerusalem, Israel; and
| | - Josh E Schroeder
- Department of Orthopedics, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Dror Ovadia
- Department of Pediatric Orthopedics, Dana Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Affiliated with the Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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2
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Costa L, van Lange A, Seevinck PR, Chu W, Vavruch L, Kruyt MC, Castelein RM, Schlosser TPC. Maturation of the vertebral ring apophysis is delayed in girls with adolescent idiopathic scoliosis compared to the normal population. Spine Deform 2024:10.1007/s43390-024-00908-w. [PMID: 38849690 DOI: 10.1007/s43390-024-00908-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 05/24/2024] [Indexed: 06/09/2024]
Abstract
PURPOSE The ring apophysis is a secondary ossification center on both sides of each vertebral body, to which the annulus of the intervertebral disc inserts. Recently, its pattern of ossification and fusion to the vertebral body was described for the normal growing spine. The aim of the present study was to investigate the ossification and fusion of the ring apophysis in patients with adolescent idiopathic scoliosis (AIS) and compare it to the normal growing population. METHODS Ring apophysis maturation along the entire thoracic and lumbar spine was analyzed on CT scans of 99 female, pre-operative AIS patients and compared to 134 CT scans of non-scoliotic girls, aged 12 to 20. RESULTS The ring apophysis maturation in AIS patients was delayed at all spinal levels in AIS patients compared to non-scoliotic controls. Ossification starts at T4-T11 at age 12, followed by T1-T5 and L3-S1 at age 15. The fusion process in AIS patients continues longer in the midthoracic region as compared to the other regions and as compared to non-scoliotic controls, with many incomplete fusions still at age 20. CONCLUSION The ring apophysis maturation in AIS is delayed compared to that in the normal population and lasts longer in the mid/low thoracic spine. Delayed maturation of the spine's most important stabilizer, while the body's dimensions continue to increase, could be part of the patho-mechanism of AIS.
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Affiliation(s)
- Lorenzo Costa
- Department of Orthopedic Surgery, University Medical Center Utrecht, G05.228, 3508 GA, P.O. Box 85500, Utrecht, The Netherlands
| | - Agnes van Lange
- Department of Orthopedic Surgery, University Medical Center Utrecht, G05.228, 3508 GA, P.O. Box 85500, Utrecht, The Netherlands
| | - Peter R Seevinck
- Department of Imaging, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Winnie Chu
- Department of Imaging and Interventional Radiology, Chinese University of Hong Kong at The Prince of Wales Hospital, Sha Tin, China
| | - Ludvig Vavruch
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Moyo C Kruyt
- Department of Orthopedic Surgery, University Medical Center Utrecht, G05.228, 3508 GA, P.O. Box 85500, Utrecht, The Netherlands
| | - René M Castelein
- Department of Orthopedic Surgery, University Medical Center Utrecht, G05.228, 3508 GA, P.O. Box 85500, Utrecht, The Netherlands
| | - Tom P C Schlosser
- Department of Orthopedic Surgery, University Medical Center Utrecht, G05.228, 3508 GA, P.O. Box 85500, Utrecht, The Netherlands.
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Essibayi MA, Zakirova M, Phipps KM, Patton CD, Fluss R, Khatri D, Raz E, Shapiro M, Dmytriw AA, Haranhalli N, Agarwal V, Altschul DJ. Outcomes of Preoperative Transophthalmic Artery Embolization of Meningiomas: A Systematic Review with a Focus on Embolization Agent. AJNR Am J Neuroradiol 2023; 44:934-938. [PMID: 37414456 PMCID: PMC10411834 DOI: 10.3174/ajnr.a7935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 06/11/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Transophthalmic artery embolization of intracranial meningiomas is thought to be associated with a high complication risk. PURPOSE With advances in endovascular techniques, we systematically reviewed the current literature to improve our understanding of the safety and efficacy of transophthalmic artery embolization of intracranial meningiomas. DATA SOURCES We performed a systematic search using PubMed from inception until August 3, 2022. STUDY SELECTION Twelve studies with 28 patients with intracranial meningiomas embolized through the transophthalmic artery were included. DATA ANALYSIS Baseline and technical characteristics and clinical and safety outcomes were collected. No statistical analysis was conducted. DATA SYNTHESIS The average age of 27 patients was 49.5 (SD, 13) years. Eighteen (69%) meningiomas were located in the anterior cranial fossa, and 8 (31%), in the sphenoid ridge/wing. Polyvinyl alcohol particles were most commonly (n = 8, 31%) used to preoperatively embolize meningiomas, followed by n-BCA in 6 (23%), Onyx in 6 (23%), Gelfoam in 5 (19%), and coils in 1 patient (4%). Complete embolization of the target meningioma feeders was reported in 8 (47%) of 17 patients; partial embolization, in 6 (32%); and suboptimal embolization, in 3 (18%). The endovascular complication rate was 16% (4 of 25), which included visual impairment in 3 (12%) patients. LIMITATIONS Selection and publication biases were limitations. CONCLUSIONS Transophthalmic artery embolization of intracranial meningiomas is feasible but is associated with a non-negligible complication rate.
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Affiliation(s)
- M A Essibayi
- From the Department of Neurological Surgery (M.A.E., M.Z., K.M.P., R.F., D.K., N.H., V.A., D.J.A.), Montefiore Medical Center
- Department of Radiology (M.A.E.), Mayo Clinic, Rochester, Minnesota
| | - M Zakirova
- From the Department of Neurological Surgery (M.A.E., M.Z., K.M.P., R.F., D.K., N.H., V.A., D.J.A.), Montefiore Medical Center
| | - K M Phipps
- From the Department of Neurological Surgery (M.A.E., M.Z., K.M.P., R.F., D.K., N.H., V.A., D.J.A.), Montefiore Medical Center
| | - C D Patton
- D. Samuel Gottesman Library (C.D.P.), Albert Einstein College of Medicine, Bronx, New York
| | - R Fluss
- From the Department of Neurological Surgery (M.A.E., M.Z., K.M.P., R.F., D.K., N.H., V.A., D.J.A.), Montefiore Medical Center
| | - D Khatri
- From the Department of Neurological Surgery (M.A.E., M.Z., K.M.P., R.F., D.K., N.H., V.A., D.J.A.), Montefiore Medical Center
| | - E Raz
- Bernard and Irene Schwartz Neurointerventional Radiology Section (E.R., M.S.), Center for Stroke and Cerebrovascular Diseases, New York University Langone Health, New York, New York
| | - M Shapiro
- Bernard and Irene Schwartz Neurointerventional Radiology Section (E.R., M.S.), Center for Stroke and Cerebrovascular Diseases, New York University Langone Health, New York, New York
| | - A A Dmytriw
- Neuroendovascular Program (A.A.D.), Massachusetts General Hospital & Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
- Neurovascular Centre (A.A.D.), Departments of Medical Imaging & Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - N Haranhalli
- From the Department of Neurological Surgery (M.A.E., M.Z., K.M.P., R.F., D.K., N.H., V.A., D.J.A.), Montefiore Medical Center
| | - V Agarwal
- From the Department of Neurological Surgery (M.A.E., M.Z., K.M.P., R.F., D.K., N.H., V.A., D.J.A.), Montefiore Medical Center
| | - D J Altschul
- From the Department of Neurological Surgery (M.A.E., M.Z., K.M.P., R.F., D.K., N.H., V.A., D.J.A.), Montefiore Medical Center
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Boeyer ME, Farid S, Wiesemann S, Hoernschemeyer DG. Outcomes of vertebral body tethering in the lumbar spine. Spine Deform 2023; 11:909-918. [PMID: 36820998 DOI: 10.1007/s43390-023-00662-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 01/21/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE The use of vertebral body tethering (VBT) for the treatment of main thoracic deformities in adolescent idiopathic scoliosis patients is becoming increasingly more common, but limited data exist on its safety and efficacy in thoracolumbar deformities. We aimed to evaluate the postoperative outcomes of patients with thoracolumbar (TL) deformities that were treated with VBT. METHODS We assessed clinical and radiographic data from twenty-eight consecutive patients that were surgically managed with VBT, all of whom exhibited a TL deformity with at least two years (mean: 44.7 ± 14.5 months) of postoperative follow-up. Standard radiographic parameters were extracted from left hand wrist and standing posterior-anterior and lateral spine radiographs at various timepoints. Outcome variables were assessed based on preoperative Lenke Classification and included: deformity measures, complications, surgical revisions, and postoperative success. RESULTS The mean age at the time of instrumentation was 13.4 ± 1.3 years, with an average preoperative Sanders Stage of 4.6 ± 1.4. A significant reduction in preoperative deformities was observed at most postoperative timepoints. A perioperative complication was observed in three patients and surgical revision was required in another four patients. A suspected broken tether was observed in sixteen patients, most of which occurred at the apex of the lumbar deformity. Only one patient required surgical revision due to a suspected broken tether. We observed an overall success rate of 57%, regardless of Lenke Classification. CONCLUSIONS These data indicate that VBT can successfully correct TL deformity patterns in 57% of patients without an increase in the rate of perioperative complications, suspected broken tethers, or surgical revisions.
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Affiliation(s)
- Melanie E Boeyer
- Department of Orthopaedic Surgery, University of Missouri, 204 N. Keene Street #102, Columbia, MO, 65201, USA
- Missouri Orthopaedic Institute, Columbia, MO, USA
| | - Sophi Farid
- School of Medicine, University of Missouri, Columbia, MO, USA
| | - Sebastian Wiesemann
- Division of Thoracic Surgery, Department of Surgery, University of Missouri, Columbia, MO, USA
| | - Daniel G Hoernschemeyer
- Department of Orthopaedic Surgery, University of Missouri, 204 N. Keene Street #102, Columbia, MO, 65201, USA.
- Missouri Orthopaedic Institute, Columbia, MO, USA.
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Advancements and Updates on Operative Techniques in Spinal Deformity. J Clin Med 2022; 11:jcm11216325. [PMID: 36362553 PMCID: PMC9657266 DOI: 10.3390/jcm11216325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 10/25/2022] [Indexed: 12/02/2022] Open
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Malik AT, Kim J, Yu E, Khan SN. Timing of Complications After Posterior Spinal Fusions in Pediatric Spine Deformity. Spine Deform 2019; 7:709-719. [PMID: 31495470 DOI: 10.1016/j.jspd.2019.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 12/17/2018] [Accepted: 01/06/2019] [Indexed: 10/26/2022]
Abstract
STUDY DESIGN Retrospective cross-sectional survey. OBJECTIVE To investigate the timing of complications after posterior spinal fusion for idiopathic and neuromuscular pediatric spine deformity. SUMMARY OF BACKGROUND DATA Evidence is limited with regard to when complications occur after posterior spinal fusions in pediatric spine deformities. METHODS The 2012-2016 American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) Pediatric database files were queried using Current Procedural Terminology codes (22800, 22802, and 22804) for patients undergoing posterior spinal fusion for idiopathic or neuromuscular deformity. Median day-of-diagnosis and interquartile ranges were calculated for database-recorded complications. RESULTS A total of 10,579 patients were included in the study. The frequency and median day of diagnosis of each complication are as follows: superficial surgical site infection (SSI) (idiopathic = 0.6%, Day 18.5; neuromuscular = 1.6%, Day 19.5), deep SSI (idiopathic = 0.5%, Day 16.0; neuromuscular = 2.3%, Day 18), organ/space SSI (idiopathic = 0.1%, Day 17; neuromuscular = 0.4%, Day 16), wound disruption (idiopathic = 0.4%, Day 15; neuromuscular = 1.2%, Day 15), pneumonia (idiopathic = 0.6%, Day 5; neuromuscular = 4.0%, Day 3), unplanned intubation (idiopathic = 0.4%, Day 2; neuromuscular = 3.5%, Day 1), urinary tract infection (idiopathic = 0.4%, Day 6; neuromuscular = 2.8%, Day 4.5), nerve injury causing neurologic deficit (idiopathic = 0.4%, Day 1; neuromuscular = 0.3%, Day 5), bleeding requiring transfusions (idiopathic = 64.6%, Day 0; neuromuscular = 74.1%, Day 0), sepsis (idiopathic = 0.3%, Day 11; neuromuscular = 2.4%, Day 12.5), and mortality (idiopathic = ∼0%, Day 5; neuromuscular = 0.4%, Day 9). CONCLUSION Understanding the timing of complications is important for patients and providers, as it reflects the need of heightened awareness and low thresholds of testing during periods of highest risks to catch complications, launch appropriate optimization protocols, and minimize the cost burden associated with readmissions. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Azeem Tariq Malik
- Department of Orthopaedics, Wexner Medical Center, The Ohio State University, 410 W 10th Ave, Columbus, OH 43210, USA
| | - Jeffery Kim
- Department of Orthopaedics, Wexner Medical Center, The Ohio State University, 410 W 10th Ave, Columbus, OH 43210, USA
| | - Elizabeth Yu
- Department of Orthopaedics, Wexner Medical Center, The Ohio State University, 410 W 10th Ave, Columbus, OH 43210, USA
| | - Safdar N Khan
- Department of Orthopaedics, Wexner Medical Center, The Ohio State University, 410 W 10th Ave, Columbus, OH 43210, USA.
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Atwal R, Stewart C. Acute scoliosis as an unusual presentation of pneumonia: A case report. Medicine (Baltimore) 2018; 97:e10580. [PMID: 29901573 PMCID: PMC6024161 DOI: 10.1097/md.0000000000010580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 04/06/2018] [Indexed: 11/25/2022] Open
Abstract
We describe the unique case of a child with pneumonia presenting with acute scoliosis and abdominal pain, without any typical features of the disease.A 10-year-old girl presented to the emergency department on 3 consecutive days with right-sided abdominal pain. There were no associated features, in particular, no fevers or respiratory symptoms. On the first 2 presentations, observation,examination, and blood test findings were unremarkable. Chest x-ray and abdominal ultrasound were also normal. On the third presentation a marked scoliosis was noted and abdominal examination revealed right-sided tenderness with rebound. The patient was admitted and a computed tomographic scan of the abdomen arranged. Unexpectedly, this revealed a right lower lobe pneumonia and associated pleural effusion. Despite treatment, the parapneumonic effusion enlarged rapidly and she developed respiratory distress, necessitating transfer to a tertiary centre.The diagnosis of pneumonia can be challenging because of a lack of respiratory signs, the masking of systemic features by antipyretic effects of first-line analgesics, and a high rate of false-negative chest radiographs. The development of acute scoliosis should lead the clinician to strongly consider pneumonia in such circumstances.
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Misterska E, Głowacki J, Głowacki M, Okręt A. Long-term effects of conservative treatment of Milwaukee brace on body image and mental health of patients with idiopathic scoliosis. PLoS One 2018; 13:e0193447. [PMID: 29474440 PMCID: PMC5825107 DOI: 10.1371/journal.pone.0193447] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 02/12/2018] [Indexed: 11/19/2022] Open
Abstract
We aimed to provide a complex assessment of adult females with adolescent idiopathic scoliosis (AIS) after a minimum of 23 years after completed Milwaukee brace treatment. In the present study, a comparison between healthy female and AIS patients’ perception of trunk disfigurement, self-image, mental health, pain level and everyday activity was made. Thirty AIS patients with a mean of 27.77 yrs (SD 3.30) after the treatment were included in the study. The control group consisted of 42 females, matching the age profile of the patient group. Study participants from both groups were examined using the same protocol, except for the radiological evaluation. Patients and healthy controls completed the Polish versions of the Scoliosis Research Society (SRS-22) and Spinal Appearance Questionnaire (SAQ). Patients additionally filled the Bad Sobberheim Stress Questionnaire-Deformity (BSSQ-Deformity) and Bad Sobberheim Stress Questionnaire-Brace (BSSQ-Brace). The study group’s SAQ results differ significantly in regard to the total score and all individual domains, indicating better functioning among healthy controls. Except for the General domain (p = 0.002), among the remaining subscales the study group’s results differed significantly at p<0.001. Considering SRS-22 results, it was revealed that the patient group scored higher, signaling better functioning with reference to pain level (p = 0.016), function/activity (p<0.001) and the total score (p<0.001). The findings add to the complexity of long-term effect evaluations of AIS, particularly amongst females treated with a Milwaukee brace. Long-term results were not conclusive in terms of nonverbal assessment of body image and emotional tension regarding the experiences of brace-wearing. Future patients can be reassured that scoliosis treated conservatively does not negatively affect everyday activity, pain level, childbearing and mental health. Subjects who declared to have psychological problems due to scoliosis had a bigger curve size after treatment and in this study than the other AIS patients.
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Affiliation(s)
- Ewa Misterska
- Department of Pedagogy and Psychology, University of Security, Poznan, Poland
- * E-mail:
| | | | - Maciej Głowacki
- Department of Pediatric Orthopaedics and Traumatology, Poznan University of Medical Sciences, Poznan, Poland
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Misterska E, Głowacki J, Okręt A, Laurentowska M, Głowacki M. Back and neck pain and function in females with adolescent idiopathic scoliosis: A follow-up at least 23 years after conservative treatment with a Milwaukee brace. PLoS One 2017; 12:e0189358. [PMID: 29228056 PMCID: PMC5724838 DOI: 10.1371/journal.pone.0189358] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 11/27/2017] [Indexed: 11/18/2022] Open
Abstract
We aimed to explore the long-term outcomes of back and neck pain and functionality in adult females with adolescent idiopathic scoliosis (AIS), who had been treated with a Milwaukee brace, in a follow-up study a minimum of 23 years after the completion of the treatment, using radiological, clinical and socio-demographical data. Thirty AIS patients (scoliosis group-SG), were included in the study based on an extensive search of Pediatric Orthopedics and Traumatology Clinic charts. All treatments were successfully completed between 1974 and 1990. In all cases, scoliosis had not been detected before the age of 10 and was not combined with any major spinal deformities at the time when the brace treatment was implemented. In those patients, the Risser sign 4 and minimum two years post-menarche was defined as a maturity, after that time the brace treatment was completed. Patients were excluded from the study if they, at the time of the follow-up examinations, suffered from any other disease leading to trunk deformity. Forty patients met the criteria for inclusion, but due to change some personal details, not all of them were contacted. Finally, 30 women returned for a follow-up evaluation. Patients' follow-up period was mean 27.77 yrs. ± SD 3.30 (range 23-35). Curvature change from the end of the treatment until the present day was mean 9.1 degrees ± SD 7.64 (range 0-27). A control group of 42 healthy females (healthy controls group-HG) matching the age profile of the patient group was randomly selected for comparative purposes.Both SG and HG completed the Polish versions of the Revised Oswestry Lower Back Pain Disability Index (RODI), the Rolland-Morris Questionnaire (RMQ), the Quebec Back Pain Disability Scale (QDS), the Neck Disability Index (NDI) and the Copenhagen Neck Functional Disability Scale (CNFDS). Descriptive statistics were calculated for demographics and baseline questionnaire scores. To determine if the investigated sample sizes are equivalent, the chi-square test was used. The chi-square test was used to compare qualitative features between persons with scoliosis and healthy controls. In addition, a Mann-Whitney test was utilized to compare differences between both groups in regard to quantitative characteristics. To establish relations between quantitative data such as e.g. age, duration of brace application, apical translation, Cobb angle, and questionnaire results, we used Spearman's rank correlation (marked as rS). To determine dependency between quantitative and qualitative characteristics, e.g. between questionnaire numerical data and marital status, place of residence or curve type, ANOVA Kruskal-Wallis test was used. A p<0.05 indicates statistical significance. Statistical calculations were performed by Statistica software. In regards to RODI, RMQ, QDS, NDI and CNFDS (both for total scores and particular sub-sections), statistically significant differences (p <0.001) between both samples were found, indicating higher levels of pain and neck and lower back pain-related disability among persons with scoliosis. Associations exist between RODI and RMQ (rS = 0.76) QDS (rS = 0.70), NDI (rS = 0.69) and CNFDS (rS = 0.60). RMQ was associated with QDS (rS = 0.71) and NDI (rS = 0.69), whereas QDS correlated with NDI (rS = 0.80) and CNFDS (rS = 0.60). NDI was also associated with CNFDS (rS = 0.81). Persons with scoliosis treated in adolescence with a Milwaukee brace display significant restrictions in everyday activities, due to lower back pain (LBP) and neck-related disabilities, compared to healthy controls. In addition, back pain is associated with curve progression in long-term follow-up after conservative treatment. Moreover, LBP-related disability coexists with restrictions experienced due to neck pain.
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Affiliation(s)
- Ewa Misterska
- Department of Pedagogy and Psychology, University of Security, Poznan, Poland
- * E-mail:
| | | | | | - Maria Laurentowska
- Department of Physiology, Poznan University of Physical Education, Poznan, Poland
| | - Maciej Głowacki
- Department of Pediatric Orthopaedics and Traumatology, Poznan University of Medical Sciences, Poznan, Poland
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Hey HWD, Wong GC, Chan CX, Lau LL, Kumar N, Thambiah JS, Ruiz JN, Liu KPG, Wong HK. Reproducibility of sagittal radiographic parameters in adolescent idiopathic scoliosis-a guide to reference values using serial imaging. Spine J 2017; 17:830-836. [PMID: 28065817 DOI: 10.1016/j.spinee.2017.01.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 11/18/2016] [Accepted: 01/03/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Knowledge of sagittal radiographic parameters in adolescent idiopathic scoliosis (AIS) patients has not yet caught up with our understanding of their roles in patients with adult spinal deformity. It is likely that more emphasis will be placed in restoring sagittal parameters for AIS patients in the future. Therefore, we need to understand how these parameters may vary in AIS to facilitate management plans. PURPOSE This study aimed to determine the reproducibility of sagittal spinal parameters on lateral film radiographs in patients with AIS. STUDY DESIGN/SETTING This was a retrospective, comparative study conducted in a tertiary health-care institution from January 2013 to February 2016 (3-year period). PATIENT SAMPLE All AIS patients who underwent deformity correction surgery from January 2013 to February 2016 and had two preoperative serial lateral radiographs taken within the time period of a month were included in the study. OUTCOME MEASURES Radiographic sagittal spinal parameters including sagittal vertical axis (SVA), cervical lordosis (CL), thoracic kyphosis (TK), thoracolumbar alignment (TL), lumbar lordosis (LL); standard spinopelvic measurements such as pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS); as well as end and apical vertebrae of cervical, thoracic, and lumbar curves were the outcome measures. METHODS All patient data were pooled from electronic medical records, and X-ray images were retrieved from Centricity Enterprise Web. Averaged X-ray measurements by two independent assessors were analyzed by comparing two radiographs of the same patients performed within a 1-month time period. Chi-squared and Wilcoxon signed-rank tests were used for categorical and continuous variables. RESULTS The study cohort comprised 138 patients, 28 men and 110 women, with a mean age of 15 years (range 11-20). Between the two lateral X-rays, there was a mean difference of 0.79 cm in SVA (p<.001), 0.70° in LL (p=.033), and 0.73° in PT (p=.010). In the combined Lenke 1 and 2 subgroup, there was a similar 0.77 cm (p=.002), 0.79° (p=.009), and 1.49° (p=.001) mean difference in SVA, LL, and PT, respectively. Additionally, there was also a 1.85° (p=.009) and 1.76° (p=.006) mean difference seen in TL and SS, respectively. The overall profile of the sagittal curves remained largely similar, with only the lumbar apex shifting from L3 to L4 during the first and the second X-rays, respectively (p<.001). This occurred for the combined Lenke 1 and 2 subgroup as well (p<.001). CONCLUSION Most radiographic sagittal spinal parameters in AIS patients are generally reproducible with some variations up to a maximum of 4°. This natural variation should be taken into account when interpreting these radiographic sagittal parameters so as to achieve the most accurate results in surgical planning.
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Affiliation(s)
- Hwee Weng Dennis Hey
- University Orthopaedics, Hand and Reconstructive Microsurgery (UOHC), National University Health System, 1E Kent Ridge Rd, NUHS Tower Block Level 11, 119228 Singapore.
| | - Gordon Chengyuan Wong
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 11, Singapore 119228, Singapore
| | - Chloe Xiaoyun Chan
- Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, NUHS Tower Block Level 11, Singapore 119228, Singapore
| | - Leok-Lim Lau
- University Orthopaedics, Hand and Reconstructive Microsurgery (UOHC), National University Health System, 1E Kent Ridge Rd, NUHS Tower Block Level 11, 119228 Singapore
| | - Naresh Kumar
- University Orthopaedics, Hand and Reconstructive Microsurgery (UOHC), National University Health System, 1E Kent Ridge Rd, NUHS Tower Block Level 11, 119228 Singapore
| | - Joseph Shantakumar Thambiah
- University Orthopaedics, Hand and Reconstructive Microsurgery (UOHC), National University Health System, 1E Kent Ridge Rd, NUHS Tower Block Level 11, 119228 Singapore
| | - John Nathaniel Ruiz
- University Orthopaedics, Hand and Reconstructive Microsurgery (UOHC), National University Health System, 1E Kent Ridge Rd, NUHS Tower Block Level 11, 119228 Singapore
| | - Ka-Po Gabriel Liu
- University Orthopaedics, Hand and Reconstructive Microsurgery (UOHC), National University Health System, 1E Kent Ridge Rd, NUHS Tower Block Level 11, 119228 Singapore
| | - Hee-Kit Wong
- University Orthopaedics, Hand and Reconstructive Microsurgery (UOHC), National University Health System, 1E Kent Ridge Rd, NUHS Tower Block Level 11, 119228 Singapore
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Hyun SJ, Kim WB, Park YS, Kim KJ, Jahng TA, Kim YJ. Adolescent Idiopathic Scoliosis Treatment by a Korean Neurosurgeon: The Changing Role for Neurosurgeons. J Korean Neurosurg Soc 2015; 58:50-3. [PMID: 26279813 PMCID: PMC4534739 DOI: 10.3340/jkns.2015.58.1.50] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Revised: 04/02/2015] [Accepted: 04/20/2015] [Indexed: 11/27/2022] Open
Abstract
Objective The purpose of this study was to evaluate radiographic/clinical outcomes of adolescent idiopathic scoliosis (AIS) patients treated by a Korean neurosurgeon. Methods Ten AIS patients were treated by a single neurosurgeon between January 2011 and September 2013 utilizing segmental instrumentation with pedicle screws. Basic demographic information, curve pattern by Lenke classification, number of levels treated, amount of correction achieved, radiographic/clinical outcomes [by Scolisis Resarch Society (SRS-22r) questionnaire] and complications were evaluated to determine the surgical results. Pulmonary function test was utilized to assess forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) before and after surgery. Results The average percentage of correction of the major structural curve was 73.6% (ranged from 64% to 81.5%). Preoperative and final postoperative absolute FVC averaged 3.03 L and 3.76 L (0.73 L increase, p=0.046), and absolute FEV1 averaged 2.63 L and 3.49 L (0.86 L increase, p=0.021). Preoperative and final postoperative average self-image and function scores of SRS-22r were, 2.6±0.5, 3.3±0.1, 4.0±0.5, and 4.6±0.0, respectively. There was a significant improvement of the self-image and function scores of SRS-22r questionnaires before and after surgery (p<0.05). There was no case of neurological deficit, infection and revision for screw malposition. One patient underwent a fusion extension surgery for shoulder asymmetry. Conclusion Radiographic/clinical outcomes of AIS patients treated by a Korean neurosurgeon were acceptable. Fundamental understanding of pediatric spinal deformity is essential for the practice of AIS surgery.
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Affiliation(s)
- Seung-Jae Hyun
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Woong-Beom Kim
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Young-Seop Park
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Ki-Jeong Kim
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Tae-Ahn Jahng
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Yongjung J Kim
- Department of Orthopaedic Surgery, Spine Service, Columbia University College of Physicians and Surgeons, New York, NY, USA
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12
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Misterska E, Glowacki M, Adamczyk K, Glowacki J, Harasymczuk J. A longitudinal study of alexithymia in relation to physical activity in adolescent females with scoliosis subjected to cheneau brace treatment: preliminary report. Spine (Phila Pa 1976) 2014; 39:E1026-34. [PMID: 25072855 DOI: 10.1097/brs.0000000000000426] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A longitudinal pilot study of changes in levels of alexithymia among females with adolescent idiopathic scoliosis (AIS) under brace treatment. OBJECTIVE To investigate the prevalence of alexithymia and to evaluate changes in alexithymia levels among female patients with AIS treated with a Cheneau brace, in comparison with healthy female adolescents. SUMMARY OF BACKGROUND DATA Alexithymia is a personality trait incorporating the following core characteristics: difficulty in identifying and describing feelings, difficulty in distinguishing between feelings and the physical sensation of emotional arousal, limited imaginal processes, and an externally oriented cognitive style. Alexithymia can be common among adolescents and young adults with severe idiopathic scoliosis. METHODS Thirty-six female patients with AIS, aged 13.4 years (standard deviation [SD], 1.7) at the beginning of the study, completed the Polish version of the Toronto Alexithymia Scale-26 (TAS-26). The second and third evaluations took place at 6 and 12 months, respectively, after the beginning of the study. Thirty-six healthy female controls were also included. RESULTS The mean TAS-26 total score was 63.4 (SD, 9.3), 59.5 (SD, 12.1), and 59.6 (SD, 12.5) during the first, second, and last patient evaluation, whereas in healthy females 60.0 (SD, 10.9). With regard to the TAS-26 total score, results differed significantly between the first and the second (P = 0.007) and between the first and the third patient evaluation (P = 0.007). Regression analysis revealed that during the second and third patient evaluation, duration of recreational sports activity had a statistically significant (P = 0.029 and P = 0.005, respectively) influence on the probability of females reporting no alexithymia. CONCLUSION The prevalence of alexithymia in healthy female controls is the same as in patients with scoliosis subjected to underarm brace treatment. Statistically significant changes with regard to TAS-26 total score and externally oriented thinking domain were found in patient sample. Physical activity in females with AIS treated nonoperatively coexists with lower scores in the TAS-26. LEVEL OF EVIDENCE 2.
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Affiliation(s)
- Ewa Misterska
- *Department of Pediatric Orthopaedics and Traumatology, Poznan University of Medical Sciences, Poland †Department of Human Developmental Psychology and Family Research, Institute of Psychology, Adam Mickiewicz University, Poland ‡Department of Paediatric Orthopaedics and Traumatology, SKN of Paediatric Orthopaedics and Traumatology; and §Department and Clinic of Surgery, Traumatology, and Pediatric Urology, Poznan University of Medical Sciences, Poland
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Barnard JG, Albright K, Morrato EH, Nowels CT, Benefield EM, Hadley-Miller NA, Kempe A, Erickson MA. Paediatric spinal fusion surgery and the transition to home-based care: provider expectations and carer experiences. HEALTH & SOCIAL CARE IN THE COMMUNITY 2013; 21:634-643. [PMID: 23647700 DOI: 10.1111/hsc.12049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/05/2013] [Indexed: 06/02/2023]
Abstract
There are more than 12 million children with special healthcare needs (CSHCNs) in the United States, many of whom require specialised health-care to treat chronic physical and developmental conditions. This study is a qualitative investigation of programme, surgical and at-home recovery experiences among CSHCNs and their family carers who participated in a spine surgical care programme at a paediatric hospital in the Western United States. The programme is designed to manage increased surgical risk and the transition of care from hospital to home for children with severe scoliosis undergoing spinal fusion surgery. We conducted 30 semi-structured in-depth interviews with 14 surgical team members and 16 family carers of children who had programme evaluations and spinal surgeries in 2006. Data were collected in 2008 and 2009 in hospital or at home locations to gather programme participation feedback from families and inform the adequacy of programme support to families during at-home recovery. Data were analysed by reflexive team and content analysis methodologies. Results showed the programme was effective at improving preoperative surgical evaluation and helping families to anticipate some aspects of the surgical experience and hospital discharge. However, the impact of spinal fusion surgery and the subsequent transition to home-based care was profoundly emotional for patients and their carers. Our data indicate that programme providers underestimated the extent of emotional trauma experienced by patients and families, particularly during the at-home recovery process. The data also suggest meaningful differences in providers' and carers' expectations for surgery. Carers' disappointment with their recovery experiences and the perceived lack of post-discharge support impacted their interpretations of and perspectives on their surgical experience. Implications of this research for surgical care programmes include the need for assessment and provision of support for physical, social, and emotional burdens experienced by patients and carers at pre-surgical, surgical and at-home recovery phases.
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Affiliation(s)
- Juliana G Barnard
- Children's Outcomes Research Program, Children's Hospital Colorado, Aurora, CO, USA
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Desai SK, Brayton A, Chua VB, Luerssen TG, Jea A. The lasting legacy of Paul Randall Harrington to pediatric spine surgery. J Neurosurg Spine 2013; 18:170-7. [DOI: 10.3171/2012.11.spine12979] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Spinal arthrodesis was the first successful treatment for scoliosis, performed by Dr. Russell A. Hibbs in 1911 and later by Dr. Fred H. Albee for tuberculosis. In 1914, Dr. H.P.H. Galloway and Dr. Hibbs began using the method to treat neuromuscular scoliosis in patients with poliomyelitis. However, this treatment approach was plagued by loss of deformity correction over time and high pseudarthrosis rates. The turning point in the operative management of spinal deformities began in 1947 with Dr. Paul Randall Harrington when he started a decade-long process to revolutionize surgical treatment of spinal deformities culminating in the advent of the Harrington Rod, the first successful implantable spinal instrumentation system. During the epoch that he was in practice, Dr. Harrington's achievement influenced the technology and art of spine surgery for his contemporaries and the coming generations of spine surgeons. The purpose of this article is to review the life of Dr. Harrington, and how he has arguably come to be known as “Father of the Modern Treatment of Scoliosis.”
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Affiliation(s)
- Sohum K. Desai
- 1Neuro-Spine Program and
- 2Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston; and
- 3Division of Neurosurgery, University of Texas Medical Branch, Galveston, Texas
| | - Alison Brayton
- 1Neuro-Spine Program and
- 2Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston; and
| | - Valerie B. Chua
- 1Neuro-Spine Program and
- 2Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston; and
| | - Thomas G. Luerssen
- 1Neuro-Spine Program and
- 2Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston; and
| | - Andrew Jea
- 1Neuro-Spine Program and
- 2Division of Pediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston; and
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Kohli L, Kaza N, Lavalley NJ, Turner KL, Byer S, Carroll SL, Roth KA. The pan erbB inhibitor PD168393 enhances lysosomal dysfunction-induced apoptotic death in malignant peripheral nerve sheath tumor cells. Neuro Oncol 2012; 14:266-77. [PMID: 22259051 DOI: 10.1093/neuonc/nor226] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Malignant peripheral nerve sheath tumors (MPNSTs) are rapidly progressive Schwann cell neoplasms. The erbB family of membrane tyrosine kinases has been implicated in MPNST mitogenesis and invasion and, thus, is a potential therapeutic target. However, tyrosine kinase inhibitors (TKIs) used alone have limited tumoricidal activity. Manipulating the autophagy lysosomal pathway in cells treated with cytostatic agents can promote apoptotic cell death in some cases. The goal of this study was to establish a mechanistic basis for formulating drug combinations to effectively trigger death in MPNST cells. We assessed the effects of the pan erbB inhibitor PD168393 on MPNST cell survival, caspase activation, and autophagy. PD168393 induced a cytostatic but not a cytotoxic response in MPNST cells that was accompanied by suppression of Akt and mTOR activation and increased autophagic activity. The effects of autophagy modulation on MPNST survival were then assessed following the induction of chloroquine (CQ)-induced lysosomal stress. In CQ-treated cells, suppression of autophagy was accompanied by increased caspase activation. In contrast, increased autophagy induction by inhibition of mTOR did not trigger cytotoxicity, possibly because of Akt activation. We thus hypothesized that dual targeting of mTOR and Akt by PD168393 would significantly increase cytotoxicity in cells exposed to lysosomal stress. We found that PD168393 and CQ in combination significantly increased cytotoxicity. We conclude that combinatorial therapies with erbB inhibitors and agents inducing lysosomal dysfunction may be an effective means of treating MPNSTs.
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Affiliation(s)
- Latika Kohli
- Departments of Pathology, University of Alabama at Birmingham, WP P210, 619 South 19th St, Birmingham, AL 35294-0017, USA
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Misterska E, Glowacki M, Harasymczuk J. Brace and deformity-related stress level in females with adolescent idiopathic scoliosis based on the Bad Sobernheim Stress Questionnaires. Med Sci Monit 2011; 17:CR83-90. [PMID: 21278693 PMCID: PMC3524700 DOI: 10.12659/msm.881392] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Accepted: 10/08/2010] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Psychopathological symptoms occur more often in chronically ill patients than in healthy populations. The aim of this study was to analyze the associations between different types of treatment and stress levels. MATERIAL/METHODS The study group consisted of 69 females, of whom 35 were treated conservatively with a Cheneau brace; the other 34 subjects were treated operatively and, after correction of scoliosis with thoracoplasty, wore a brace for 12 weeks during the postoperative period. Patients completed the Polish versions of the Bad Sobernheim Stress Questionnaire-Deformity and the Bad Sobernheim Stress Questionnaire-Brace. RESULTS Patients who were treated surgically felt a moderate level of stress connected with wearing the brace and with body deformation. The group treated conservatively felt moderate stress connected with wearing the brace, but a low level of stress in relation to body deformation. The groups differed significantly statistically in the level of stress felt regarding body deformation (p=0.004). In the group treated conservatively, the correlation between the level of stress, the age at which treatment was initiated, and degree of apical translation proved to be significant. CONCLUSIONS Patients treated surgically in comparison with patients treated conservatively report higher stress levels connected with body deformation. A higher level of stress depends on the degree of trunk deformation on the frontal plane; stress is also higher in patients who begin conservative treatment at a later age.
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Affiliation(s)
- Ewa Misterska
- Department of Pediatric Orthopaedics, Poznan University of Medical Sciences, Poznan, Poland.
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Comparative Intermediate and Long-term Results of Pedicle Screw and Hook Instrumentation in Posterior Correction and Fusion of Idiopathic Thoracic Scoliosis. ACTA ACUST UNITED AC 2010; 23:467-73. [DOI: 10.1097/bsd.0b013e3181bf6797] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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18
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Kim EL, Wüstenberg R, Rübsam A, Schmitz-Salue C, Warnecke G, Bücker EM, Pettkus N, Speidel D, Rohde V, Schulz-Schaeffer W, Deppert W, Giese A. Chloroquine activates the p53 pathway and induces apoptosis in human glioma cells. Neuro Oncol 2010; 12:389-400. [PMID: 20308316 PMCID: PMC2940600 DOI: 10.1093/neuonc/nop046] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Glioblastoma is the most common malignant brain tumor in adults. The currently available treatments offer only a palliative survival advantage and the need for effective treatments remains an urgent priority. Activation of the p53 growth suppression/apoptotic pathway is one of the promising strategies in targeting glioma cells. We show that the quinoline derivative chloroquine activates the p53 pathway and suppresses growth of glioma cells in vitro and in vivo in an orthotopic (U87MG) human glioblastoma mouse model. Induction of apoptosis is one of the mechanisms underlying the effects of chloroquine on suppressing glioma cell growth and viability. siRNA-mediated downregulation of p53 in wild-type but not mutant p53 glioblastoma cells substantially impaired chloroquine-induced apoptosis. In addition to its p53-activating effects, chloroquine may also inhibit glioma cell growth via p53-independent mechanisms. Our results clarify the mechanistic basis underlying the antineoplastic effect of chloroquine and reveal its therapeutic potential as an adjunct to glioma chemotherapy.
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Affiliation(s)
- Ella L Kim
- The Translational Neurooncology Research Group, Department of Neurosurgery, Georg-August University Göttingen, Robert-Koch-Strasse 40, 37075 Göttingen, Germany.
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Wang L, Luo ZJ, Luo LJ, Feng LJ, Meng H. The effect of pedicle screw insertion through the neurocentral cartilage on the growth of immature canine vertebra. Orthop Surg 2009; 1:137-43. [PMID: 22009831 DOI: 10.1111/j.1757-7861.2009.00015.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To explore the influence of pedicle screw insertion through the neurocentral cartilage (NCC) on the development of vertebrae and spinal canal in an animal experiment. METHODS Sixteen dogs were randomly assigned to three groups: in group 1, posterior muscles at the surgery site were dissected; in group 2, the pedicles were drilled through the NCC by screws; in group 3, screws were placed in the pedicles through the NCC. Vertebrae of T8, T10, T12, L2, L4 and L6 were studied with the average data of the adjacent two vertebrae serving as controls. Spiral computerized tomography (CT) was used to assess the morphologic parameters of studied vertebrae and their controls. Measurements were made by an independent radiologist on the first post-operative day and 3 months after operation. Paired Student's t-tests of studied vertebrae and their controls were performed to evaluate the effect of pedicle screw insertion. RESULTS In group 3, 3 months after operation the area, transverse diameter and anterior-posterior diameter of the vertebral canal and length of pedicle of studied vertebrae were significantly smaller than those of control vertebrae (P < 0.05). There were no significant differences in morphologic parameters between the studied vertebrae and the control vertebrae in groups 1 and 2 (P > 0.05). CONCLUSION (i) Pedicle screw placement has a significant impact on the growth of the canine vertebra canal, and may lead to iatrogenic spinal stenosis, but their placement has no significant effect on the vertebral bodies; and (ii) the NCC can repair itself automatically. Drilling pedicle bone through the NCC with a screw and then removing the screw has no obvious impact on the growth of vertebrae.
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Affiliation(s)
- Liang Wang
- Department of Orthopaedics, No. 89 Hospital, Weifang, Shandong Province, China
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Patil CG, Santarelli J, Lad SP, Ho C, Tian W, Boakye M. Inpatient complications, mortality, and discharge disposition after surgical correction of idiopathic scoliosis: a national perspective. Spine J 2008; 8:904-10. [PMID: 18358787 DOI: 10.1016/j.spinee.2008.02.002] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2007] [Revised: 07/16/2007] [Accepted: 02/01/2008] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Information about complications and mortality after surgery for correction of idiopathic scoliosis has been largely derived from single-institution series. Regional or national studies have been lacking. PURPOSE To report inpatient mortality, complications, and discharge disposition after surgical correction of idiopathic scoliosis on a national level. STUDY DESIGN Retrospective cohort study using National Inpatient Sample (NIS) administrative data. PATIENT SAMPLE All patients in the NIS with the primary diagnosis of idiopathic scoliosis who underwent a spinal fusion between 1993 and 2002 were included. OUTCOME MEASURES Inpatient complication rate, mortality rate, and adverse outcome defined by death or discharge to institution other than home. METHODS Outcome measures were abstracted from the NIS. Univariate and multivariate analyses were performed to analyze the effects of patient and hospital characteristics on outcome measures. RESULTS The NIS was used to identify 51,911 patients who underwent spinal fusion for idiopathic scoliosis in the United States from 1993 to 2002. The total inhospital complication rate was 14.9% for pediatric patients and 25.1% for adult patients. The inhospital mortality rate was 0.17% and 0.40% for pediatric and adult patients, respectively. Adverse outcome was noted in 2.3% of pediatric patients and 20.4% of adult patients. Pulmonary and postoperative hemorrhages/hematomas were the most common complications reported. Multivariate analysis for complications showed that morbidity was significantly lower for pediatric patients (odds ratio [OR] = 0.80; confidence interval [CI] = 0.68-0.94) and female patients (OR = 0.77; CI = 0.68-0.88). Patients with a preoperative comorbidity were 1.53 (CI = 1.32-1.76) times more likely to develop a complication. A single postoperative complication increased the mean length of stay by more than 2 days and increased the mortality rate, adverse outcome, and hospital charges significantly. CONCLUSIONS We have provided a national perspective on inpatient complications, mortality, and discharge disposition after spinal fusion for idiopathic scoliosis in the United States. The significant negative effects of postoperative complications on mortality and resource utilization have been demonstrated. Furthermore, we have identified adult age, male gender, and preoperative comorbidity as important risk factors and defined their impact on patient outcomes.
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Affiliation(s)
- Chirag G Patil
- Department of Neurosurgery, Stanford University School of Medicine, 300 Pasteur Drive Room R200, MC5327, Stanford, CA 94305, USA.
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Smith JS, Fu KM, Urban P, Shaffrey CI. Neurological symptoms and deficits in adults with scoliosis who present to a surgical clinic: incidence and association with the choice of operative versus nonoperative management. J Neurosurg Spine 2008; 9:326-31. [DOI: 10.3171/spi.2008.9.10.326] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Adults with scoliosis often present with neurological symptoms and deficits. However, the incidence of these findings and how they may affect treatment decisions have not been clearly defined. The purpose of this study was to quantify the prevalence of neurological symptoms and deficits in adults with scoliosis presenting to a surgical clinic, and to assess for an association between these factors and the decision to pursue operative treatment.
Methods
In this study, the authors document the Oswestry Disability Index (ODI), radiographic findings, and the incidences of back pain, neurological symptoms (radiculopathy and claudication), and neurological deficits (weakness, myelopathy, and bowel/bladder dysfunction) and correlate these with operative versus nonoperative management. Pain was assessed using the visual analog scale (VAS) score. Of 207 patients, 25% underwent surgery.
Results
Incidences of back pain (VAS score > 0 points) and radiculopathy (VAS score > 0) were 99 and 85%, respectively. The incidences of severe (VAS score > 5) back pain and radiculopathy were 66 and 47%, respectively. Neurological symptoms and deficits included weakness in 8% of patients, claudication in 9%, myelopathy in 1%, and bowel/bladder dysfunction in 3%. Patients with severe radiculopathy had greater mean ODI scores (p < 0.001) and reduced lumbar lordosis (p = 0.04) and were more likely to have de novo scoliosis (p = 0.009). Patients who underwent surgery had higher ODI scores (p < 0.001) and a greater incidence of severe radiculopathy (p = 0.006), weakness (p < 0.001), and neurogenic claudication (p = 0.003). Factors associated with operative management on multivariate analysis included weakness (p < 0.001), severe radiculopathy (p = 0.02), and sagittal imbalance (p = 0.03).
Conclusions
Neurological symptoms and deficits are common among adults with scoliosis. Development of neurological symptoms and/or deficits is strongly associated with the decision to pursue operative treatment.
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Smith JS, Shaffrey CI, Kuntz C, Mummaneni PV. CLASSIFICATION SYSTEMS FOR ADOLESCENT AND ADULT SCOLIOSIS. Neurosurgery 2008; 63:16-24. [DOI: 10.1227/01.neu.0000320447.61835.ea] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
ABSTRACT
OBJECTIVE
To review current classification systems for adolescent and adult scoliosis.
METHODS
The literature was reviewed in reference to scoliosis classification systems for adolescent and adult scoliosis.
RESULTS
There are multiple classification systems for scoliosis. Classification of scoliosis is dependent on patient age, spinal abnormality, scoliotic curve, and global spinal alignment. To date, classification systems have focused predominantly on adolescent idiopathic scoliosis or adult/degenerative scoliosis; a single classification system evaluating scoliotic deformities of different ages and spinal abnormalities has not been identified.
CONCLUSION
The importance of scoliosis classification schemes lies in their ability to standardize communication among health care providers. With regard to the classification of adolescent scoliosis, the Lenke system has addressed many of the significant limitations of the King system and is now the standard classification scheme. Classification schemes for adult scoliosis have been reported only recently, and each offers specific advantages (the simple pathogenesis-based system of Aebi, the strong clinical relevance of the Schwab system, and the richly descriptive Scoliosis Research Society system). This article highlights the salient features of currently used scoliosis classification systems.
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Affiliation(s)
- Justin S. Smith
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | | | - Charles Kuntz
- Department of Neurosurgery, University of Cincinnati, Mayfield Clinic and Spine Institute, Cincinnati, Ohio
| | - Praveen V. Mummaneni
- Department of Neurosurgery, UCSF Spine Center, University of California, San Francisco, San Francisco, California
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Herrera-Soto JA, Crawford AH. Idiopathic scoliosis in children and adolescents: diagnosis and treatment options. ACTA ACUST UNITED AC 2008. [DOI: 10.2217/17455111.2.1.89] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Scoliosis is characterized by a 3D deformity of the spine. It causes anxiety in the family and the patient. Several factors alter its treatment. Skeletal immature patients and those with congenital anomalies are more prone to develop serious deformities. Posterior spinal fusion is the mainstay of treatment. The implants to be used must be carefully chosen. Parents need to be aware that the surgeons primary goal is stabilize and correct the deformity to prevent it’s progression in the safest possible way.
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Affiliation(s)
- José A Herrera-Soto
- Assistant Program Director of Pediatric, Orthopedic Fellowship Orlando Regional Healthcare, Orlando, FL, USA
| | - Alvin H Crawford
- Cincinnati Children Hospital Medical Center, 3333 Burnet AvenueCincinnati, OH 45229, USA
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Spinal deformities in hereditary motor and sensory neuropathy: a retrospective qualitative, quantitative, genotypical, and familial analysis of 175 patients. Spine (Phila Pa 1976) 2007; 32:2502-8. [PMID: 18090092 DOI: 10.1097/brs.0b013e3181573d4e] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective study of 175 patients with hereditary motor and sensory neuropathy (HMSN), i.e., Charcot-Marie-Tooth (CMT) disease. OBJECTIVE To investigate the frequency, age of onset, character, familial, and genotypical incidence of spinal deformities among HMSN patients. SUMMARY OF BACKGROUND DATA Prior studies addressing HMSN discuss the associated spinal deformities. However, these data vary significantly while inconsistently including genotypes within the classification framework. METHODS Plain-film radiographic spine studies of 175 HMSN patients were performed to determine the incidence, character, and severity of spinal deformity. The degree of the spinal deformity was evaluated measuring Cobb's angle of the main curve. The results of the entire cohort were initially assessed before being classified by genotype. RESULTS The incidence of spinal deformity for the entire group was 26%. Of these, 58% demonstrated scoliosis, 31% had kyphoscoliosis, and 11% had thoracic hyperkyphosis; 73% of patients with spinal deformity were classified as HMSN Type I with confirmed duplication of the PMP 22 (peripheral myelin protein) gene on chromosome 17. The incidence of spinal deformity by genotype was: duplication of the PMP 22 gene: 29% (25 of 87); deletion of the PMP 22 gene: 0% (0 of 15); Cx32 (connexin 32) gene mutation: 24% (8 of 34); and MPZ (myelin protein zero) gene mutation: 100% (6 of 6). Familial incidence of spinal deformity was found in "MPZ gene mutation" and "duplication of PMP 22 gene" subgroups. CONCLUSION This study demonstrates a 26% incidence of spinal deformity among HMSN patients. Spinal deformity was most frequently observed in patients with the MPZ gene mutation, where the most common familial incidence was also found.
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Abstract
Pediatric spinal deformity is a common manifestation of multiple disorders. The clinical picture varies depending on the age at presentation, the severity of the curve at the time of diagnosis, and the underlying cause. Knowledge of the natural history of these varied conditions, the dynamics of growth in the developing spine, and normal axial skeletal biomechanics are fundamental in planning an appropriate treatment. Furthermore, in many instances the spinal anomaly is just part of the problem in a globally affected patient. Treatment alternatives must be judged based on their capacity to positively alter the natural course of the disease and provide a long-standing solution into a patient's adulthood.
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Affiliation(s)
- Mauricio A Campos
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA
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Benameur S, Mignotte M, Destrempes F, De Guise JA. Three-dimensional biplanar reconstruction of scoliotic rib cage using the estimation of a mixture of probabilistic prior models. IEEE Trans Biomed Eng 2005; 52:1713-28. [PMID: 16235657 DOI: 10.1109/tbme.2005.855717] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In this paper, we present an original method for the three-dimensional (3-D) reconstruction of the scoliotic rib cage from a planar and a conventional pair of calibrated radiographic images (postero-anterior with normal incidence and lateral). To this end, we first present a robust method for estimating the model parameters in a mixture of probabilistic principal component analyzers (PPCA). This method is based on the stochastic expectation maximization (SEM) algorithm. Parameters of this mixture model are used to constrain the 3-D biplanar reconstruction problem of scoliotic rib cage. More precisely, the proposed PPCA mixture model is exploited for dimensionality reduction and to obtain a set of probabilistic prior models associated with each detected class of pathological deformations observed on a representative training scoliotic rib cage population. By using an appropriate likelihood, for each considered class-conditional prior model, the proposed 3-D reconstruction is stated as an energy function minimization problem, which is solved with an exploration/selection algorithm. The optimal 3-D reconstruction then corresponds to the class of deformation and parameters leading to the minimal energy. This 3-D method of reconstruction has been successfully tested and validated on a database of 20 pairs of biplanar radiographic images of scoliotic patients, yielding very promising results. As an alternative to computed tomography-scan 3-D reconstruction this scheme has the advantage of low radiation for the patient, and may also be used for diagnosis and evaluation of deformity of a scoliotic rib cage. The proposed method remains sufficiently general to be applied to other reconstruction problems for which a database of objects to be reconstructed is available (with two or more radiographic views).
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Affiliation(s)
- Said Benameur
- Laboratoire de recherche en imagerie et orthopédie, University of Montréal Hospital Research Centre, Montréal, QC H2L 2W5, Canada.
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Johnson JP, Pashman RS, Lauryssen C, Anand N, Regan JJ, Bray RS. The changing role for neurosurgeons and the treatment of spinal deformity. J Neurosurg Spine 2005; 2:233-42. [PMID: 15796346 DOI: 10.3171/spi.2005.2.3.0233] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
✓ Spinal deformity has classically and historically been studied by those in the discipline of orthopedic surgery. This may be attributable to the orthopedic interventionalists' experience with osseous fixation for long-bone and other skeletal fractures. Neurosurgeons have maintained a long-standing interest in complex cervical spinal disorders, and their interest in the larger field of complex spinal deformity has been expanding.
An understanding of spinal deformity disorders, biomechanics, bone biology, and metallurgy is necessary before clinical, teaching, and research activities can be undertaken within neurosurgery.
The authors describe basic and advanced concepts of spinal deformity management with cases to illustrate teaching points.
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Affiliation(s)
- J Patrick Johnson
- Institute for Spinal Disorders, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
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