Purpose of the study: Data are scarce on the long-term outcome after anterior spinal fusion for idiopathic scoliosis in adolescents. The purpose of this study was to assess the clinical and radiological results obtained in a monocentric series using a single-phase fusion with pre-formed plates for the treatment of lumbar, thoracolum-bar and thoracic idiopathic scoliosis in adolescents.

Material and method: This procedure was performed in 111 patients from 1975 to 1993. Complete clinical and radiological evaluations were available for 35 patients, 7 male and 28 female. The SRS-30 questionnaire (translated into French by the authors) and the Oswestry score were used to assess functional outcome. Radiographic data were collected by an independent observer who read the pre-, post- and last follow-up images. Full spine images were available to assess correction of the curvature, frontal and sagittal balance, pelvic parameters, and degenerative changes in the subjacent discs. Functional outcome was assessed in relation to the radiographic findings.

Results: Mean follow-up was 22 years (range 16–31). Mean age at surgery was 14.5 years. At last follow-up, none of the patients were unemployed because of a spinal problem and 21 women had had one or more successful pregnancies. The mean SRS-30 score was 3.8/5 and correlated with the Oswestry score (13.8%). One patient underwent revision for disc herniation and one for posterolateral lumbosacral fusion because of persistent frontal imbalance. There as a fracture of the proximal screw in six patients with no sign of nonunion. At last follow-up, the mean Cobb angle was 14 (0–42). Frontal imbalance was noted in 18 patients, mean 12 mm. In the sagittal plane, three patients presented anterior imbalance. The pelvic parameters were within the range of the general population. Signs of L5-S1 disc degeneration were noted in ten patients, with no correlation with functional outcome.

Conclusion: Anterior fusion gives good long-term functional results in the treatment of idiopathic scoliosis in adolescents. Patients can pursue a normal occupational and familial life. This technique has provided satisfactory correction in the frontal and sagittal planes.

Purpose of the study: We noted that four postoperative compartment syndromes observed in our department occurred in short stature patients with micromely secondary to chondrodysplasia. This complication occurred in young subjects with significant muscular development (two with intensive sports practice) whose muscle hypertrophy appeared exaggerated by the short length of the limbs.

Material and methods: The first case concerned a young man with pycnodysostosis who developed a tibial compartment syndrome after prolonged ventral decubitus subsequent to spinal surgery. No surgical procedure had been performed on the lower limb. The complication was probably triggered by simple compression of the proximal portion of the limb leading to elevated venous pressure and rapid self-aggravating muscular atrophy in a small aponeurotic compartment. The second case was a female patient with metaphyseal dysplasia who during adolescence had undergone corrective bilateral tibial osteotomy to align the lower limbs. Preventive aponeurotomy had been performed which left on one side a disgraceful muscle herniation. Aponeurotic plasty had been performed in adulthood to reconstitute the tibial compartment. A compartment syndrome developed in the immediate postoperative period. The third case was a young adult with hypochondroplasia who developed bilateral crural compartment syndrome 24 hours after femoral osteotomy with implantation of an external fixator for lower limb lengthening.

Results: Sequelae were observed in only one of these four cases of compartment syndrome (patient n° 1). Extensive necrosis of the tibialis anterior was observed due to late diagnosis, leading to legal implications and a court suit. Emergency treatment was given in the three other cases and no sequelae were observed.

Discussion: These patients with chondrodysplasia and micromely appeared to be predisposed to postoperative compartment syndrome because of the relative muscle hypertrophy and the narrow muscle compartments. The risk of this complication in small stature patients warrants the use of preventive aponeurotomy during orthopedic procedures involving the limbs and implies rigorous postoperative surveillance for early detection. Systematic aponeurotomies should be extended over the entire length of the muscle compartment involved in order to achieve effective decompression and avoid disgraceful localized muscle herniation.

Purpose of the study: Determine the prevalence and course of spinal deformations in Willi-Prader syndrome and assess the effect of treatment with growth hormone. Analyze outcome after conservative and surgical treatments.

Material and methods: We reviewed the files of 51 patients with Willi-Prader syndrome proven genetically. Spinal deformations were classed according to the SRS system. Body mass index (BMI) was determined and correlated with age and administration of growth hormone. Statistical analysis used the coefficient of correlation and the chi-square test to search for correlations between qualitative variables.

Results: There were 37 girls and 24 boys, mean age at last follow-up 10.7±6.7 years. The prevalence of scoliosis was 52% and varied according to genotype.

The prevalence of scoliosis deformations was higher in patients aged over ten years (p< 0.01). The prevalence of scoliosis was greater in female patients. Patients with BMI< 25 had a significantly lower risk of scoliosis. Treatment with growth hormone was associated with a significant decrease in risk of scoliosis. Among scoliosis patients, ten had a main curvature < 15° and were monitored. Eleven had a curvature > 15° (31±11°) and were treated with a corset. Five had a curvature > 50° and trunk imbalance and were treated surgically. Four of these patients developed serious complications.

Discussion: Scoliosis deformation is frequent in Willi-Prader syndrome. Weight control is very important and BMI should be maintained below 25 to limit the risk of scoliosis. Treatment with growth hormone helps limit BMI and thus the risk of scoliosis. For major deformations, surgical treatment is indicated but at the risk of serious postoperative complications.