Aims

To provide normative data that can assess spinal-related disability and the prevalence of back or leg pain among adults with no spinal conditions in the UK using validated questionnaires.

The development of spinal deformity in children with underlying neurodisability can affect their ability to function and impact on their quality of life, as well as compromise provision of nursing care. Patients with neuromuscular spinal deformity are among the most challenging due to the number and complexity of medical comorbidities that increase the risk for severe intraoperative or postoperative complications. A multidisciplinary approach is mandatory at every stage to ensure that all nonoperative measures have been applied, and that the treatment goals have been clearly defined and agreed with the family. This will involve input from multiple specialities, including allied healthcare professionals, such as physiotherapists and wheelchair services. Surgery should be considered when there is significant impact on the patients’ quality of life, which is usually due to poor sitting balance, back or costo-pelvic pain, respiratory complications, or problems with self-care and feeding. Meticulous preoperative assessment is required, along with careful consideration of the nature of the deformity and the problems that it is causing. Surgery can achieve good curve correction and results in high levels of satisfaction from the patients and their caregivers. Modern modular posterior instrumentation systems allow an effective deformity correction. However, the risks of surgery remain high, and involvement of the family at all stages of decision-making is required in order to balance the risks and anticipated gains of the procedure, and to select those patients who can mostly benefit from spinal correction.

Aims

High-grade dysplastic spondylolisthesis is a disabling disorder for which many different operative techniques have been described. The aim of this study is to evaluate Scoliosis Research Society 22-item (SRS-22r) scores, global balance, and regional spino-pelvic alignment from two to 25 years after surgery for high-grade dysplastic spondylolisthesis using an all-posterior partial reduction, transfixation technique.

Aims

Severe spinal deformity in growing patients often requires surgical management. We describe the incidence of spinal deformity surgery in a National Health Service.

Purpose of the study

Two patients with very severe thoracolumbar Scheuermann's kyphosis who developed spontaneous bony fusion across the apex of the deformity are presented and their treatment, as well as surgical outcome is discussed.

Purpose of the study

We report septic shock as postoperative complication following an instrumented posterior spinal arthrodesis on a patient with multiple body piercings. The management of this potentially catastrophic complication and outcome of treatment is been discussed.

Purpose of the study

To investigate the efficacy of pedicle screw instrumentation in correcting spinal deformity in patients with quadriplegic cerebral palsy. Also to assess quality of life and functional improvement after deformity correction as perceived by the parents of our patients.

Purpose of the study

To investigate the efficacy of pedicle screw instrumentation in correcting thoracolumbar/lumbar idiopathic scoliosis in adolescent patients.

Purpose of the study

To compare the effectiveness of unilateral and bilateral pedicle screw techniques in correcting adolescent idiopathic scoliosis.

Summary of background data. The development of a spinal deformity, usually affecting the coronal and occasionally the sagittal balance of the spine is a recognised complication of paralysis following a spinal cord injury (SCI) occurring in childhood.

Purpose of the study. The aim of the present study was to report our experience on the surgical treatment of patients who developed a paralytic spinal deformity secondary to SCIs occurring in childhood.

Material-Methods. Our study cohort comprised 18 consecutive patients with a paralytic spinal deformity as a consequence of a SCI. The cause of paralysis in this group of patients included a traumatic incident in 10 patients, spinal cord tumour in 6 patients, vascular injury to the neural cord during cardiac surgery in one patient, and meningitis in one patient. Twelve patients presented with high- or mid-thoracic paraparesis, which was complete in all but two patients. Six patients developed tetraparesis, which was incomplete in 3 of these patients.

Results. Fourteen patients underwent surgical correction of their spinal deformities; 11 patients had a scoliosis, 2 had a lordoscoliosis, and one had a kyphosis. The mean age at spinal arthrodesis was 13.4 years. Eleven patients underwent a posterior spinal fusion alone and 3 patients underwent a combined anterior and posterior spinal arthrodesis. Posterior spinal instrumentation with bilateral Luque rods and segmental fixation with sublaminar wires was used in all but one patient who was stabilised with the use of third generation spinal instrumentation. The spinal fusion extended to the sacrum in 10 of the 14 patients (71.4%) using the Galveston technique of intra-iliac pelvic fixation.

None of the patients developed postoperative wound infections, either early or late. There were no major medical complications following surgery in this group of patients that would result in prolonged intensive care unit or hospital stay. Four of the 14 patients (28.6%) who had initially undergone a posterior spinal arthrodesis alone developed an asymptomatic pseudarthrosis with failure of the instrumentation. The non-union was treated successfully in 2 of these 4 patients with a combined anterior and posterior spinal fusion. The repair of the pseudarthrosis was performed through a repeat posterior spinal fusion in the remaining 2 patients and one of these patients necessitated a second revision procedure to address recurrence of the non-union.

Conclusions. The high rate of pseudarthrosis (28.6%) recorded in the present series suggests that a combined anterior and posterior spinal arthrodesis could be considered as the initial treatment of choice for patients who are at a good general medical condition to tolerate anterior surgery and who have severe deformities. If pseudarthrosis develops following an isolated posterior spinal fusion, this can be treated more effectively by a combined anterior and posterior revision procedure with the use of instrumentation, which can increase the chances for a successful outcome.

Summary of Background Data. Obstruction of the third part of the duodenum by the superior mesenteric artery (SMA) is associated with spinal manipulation in the surgical or conservative management of scoliosis.

Purpose of the study. The aim of the present study was to investigate the prevalence of SMA syndrome in a cohort of 165 consecutive pediatric patients who underwent spine deformity surgery and had minimum 2-year follow-up.

Material-Methods. The study group comprised 85 patients with idiopathic scoliosis, 20 patients with neuromuscular and 18 patients with miscellaneous or syndromic scoliosis, and 42 patients with congenital spinal deformities. Posterior spinal arthrodesis was performed in 94 patients, combined anterior/posterior in 60 patients, and anterior spinal fusion in 11 patients.

Results. We identified 4 patients who developed SMA syndrome postoperatively. These were all markedly underweight, adolescent females; 2 patients had adolescent idiopathic scoliosis, one had neuromuscular, and one congenital scoliosis. Third generation instrumentation systems with derotational effect were used in 3 patients. The spinal arthrodesis in the patient with neuromuscular scoliosis was performed using bone graft followed by application of a spinal jacket. The symptoms developed at a mean of 3.7 days post-surgery and included nausea, vomiting, increased nasogastric aspirates, abdominal pain and distension. Conservative management with prolonged nasojejunal feedings achieved resolution of the symptoms in all but one patient, who required derotation of the duodenum and jejunum. There was no evidence of recurrence of the condition in any patient at the latest follow-up.

Conclusions. The prevalence of SMA syndrome in our series was 2.4%. This draws attention to the significance of prevention of the condition by recognizing patients who are at a higher risk. An early diagnosis of the syndrome will allow for application of conservative methods and will increase the chances for a successful outcome.

Summary of Background Data: The craniofacial malformations described by Goldenhar can be associated with congenital anomalies of the vertebrae. This non-random association of abnormalities represents unilateral errors in the morphogenesis of the spine, as well as the first and second branchial arches.

Purpose of the study: The aim of the present study was to determine the prevalence of Goldenhar related conditions in patients with congenital deformities of the spine and to describe the types of vertebral abnormalities and the necessity for treatment.

Material-Methods: We performed a retrospective study of 668 consecutive patients with congenital deformities of the spine. The medical records and spinal radiographs were reviewed and patients with a Goldenhar associated condition were identified. The vertebral anomalies causing the spine deformity were detected on antero-posterior and lateral spine radiographs. The type and site of the craniofacial abnormalities, as well as other musculoskeletal deformities and systemic anomalies were recorded.

Results: Fourteen patients had Goldenhar associated conditions (7 males and 7 females). A thoracic scoliosis was the most common type of deformity occurring in ten patients (71.5%). Eight of these patients had an isolated hemivertebra and the remaining two had a unilateral unsegmented bar with contralateral hemivertebra at the same level. There was only one patient with a lumbar scoliosis and this was due to a hemivertebra. The side of the vertebral anomaly correlated with that of the hemifacial microsomia in five of the eleven patients who had a scoliosis or kyphoscoliosis. A thoracolumbar kyphosis occurred in four patients; two had posterior hemivertebrae, one had wedge vertebrae, and the remaining patient had an anterior unsegmented bar. A thoracolum-bar kyphoscoliosis occurred in only one patient and was due to a posterolateral quadrant vertebra. Klippel-Feil syndrome occurred in six patients (42.8%).

Eight patients (57%) underwent surgical treatment at a mean age of 9.8 years (range: 2.9–19). Four patients had a combined anterior-posterior spine arthrodesis. The remaining four patients had a posterior spinal arthrodesis.

Conclusions. The prevalence of Goldenhar associated conditions in patients with congenital deformities of the spine was 2%. Failures of vertebral segmentation were the most frequent abnormality in the cervical spine, whereas failures of vertebral formation most commonly occurred in the thoracic or thoracolumbar spine.