Introduction. Deformity influences the weight bearing stresses on the knee joint. Correction of mechanical alignment is performed to offload the knee and slow the rate of degenerative change. Fixator assisted
Aims. The aim of this retrospective cohort study was to assess and investigate the safety and efficacy of using a distal tibial osteotomy compared to proximal osteotomy for limb lengthening in children. Methods. In this study, there were 59 consecutive tibial lengthening and
Aims. Severe spinal deformity in growing patients often requires surgical management. We describe the incidence of spinal
Aims. Temporary hemiepiphysiodesis (HED) is applied to children and adolescents to correct angular deformities (ADs) in long bones through guided growth. Traditional Blount staples or two-hole plates are mainly used for this indication. Despite precise surgical techniques and attentive postoperative follow-up, implant-associated complications are frequently described. To address these pitfalls, a flexible staple was developed to combine the advantages of the established implants. This study provides the first results of guided growth using the new implant and compares these with the established two-hole plates and Blount staples. Methods. Between January 2013 and December 2016, 138 patients (22 children, 116 adolescents) with genu valgum or genu varum were treated with 285 flexible staples. The minimum follow-up was 24 months. These results were compared with 98 patients treated with 205 two-hole plates and 92 patients treated with 535 Blount staples. In long-standing anteroposterior radiographs, mechanical axis deviations (MADs) were measured before and during treatment to analyze treatment efficiency. The evaluation of the new flexible staple was performed according to the idea, development, evaluation, assessment, long-term (IDEAL) study framework (Stage 2a). Results. Overall, 79% (109/138) of patients treated with flexible staples achieved sufficient
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
Aims. Spinal
Intrathecal morphine (IM) is a common adjunct in paediatric spinal
Introduction: The natural history of scoliosis in the presence of a cord syrinx, either treated conservatively, or post surgically, is disputed. It is generally believed to be associated with a greater likelihood of rapid deformity progression pre-operatively and a much greater likelihood of intraoperative neural injury. In this study we aimed to retrospectively assess the local experience by reviewing patients, treated over the last 10 years, in whom scoliosis has been established, by means of MR imaging, to be associated with a cord syrinx. Methods: A retrospective cohort study was undertaken of paediatric patients attending the Leeds Spinal Unit between the years of 1997 and 2007. The entry criteria for this study were spinal deformity with MRI proven cord syrinx, in a patient without underlying tumour or other cord anomaly. Given the association with Chiari malformation this was a measured parameter rather than exclusion criteria. Other parameters assessed were mode of presentation, progression of scoliosis, details of the identified syrinx, chosen mode of treatment for the syrinx and the scoliosis (including conservative) and outcome measures (neurological function and sequelae, change in Cobb angle/deformity correction). Results: A total of 46 patients were identified with scoliosis and an associated syrinx. The age range was from 3 to 18 years. Only 12 were male. The syrinx was associated with an Arnold Chiari malformation in 24% of patients, and located at the apex of, or local to, the maximum deformity in 73%. The syrinx was treated surgically in 10 patients, with 80% of these achieving either deformity arrest, or no longer requiring surgical
Objective: Determine the incidence of abnormal somatosensory evoked potentials (SSEP) in patients with ‘at risk’ spinal cords undergoing anterior spinal
Objective: Recent reports have suggested a low incidence of neurological complications following anterior
Aims. The aims of this prospective study were to determine the effect of osteophyte excision on
Aim:. Deep infection following paediatric spinal
Introduction. Lower limb mal-alignment as a result of fracture malunion can result in knee degenerative arthritis or predispose to early arthroplasty failure due to the altered mechanical axis. The choice of corrective osteotomy is often determined by potential complications. Opening wedge osteotomy is associated with poor bone healing especially in adult diaphyseal bone. Distraction osteogenesis enables gradual
Purpose. The purpose of this study was to assess the accuracy of three-dimensional camera technology when monitoring
The aim of the study was to review the effectiveness of rigid IM nailing in stabilisation and
Aims: To review the presentation, progression, treatment, and outcome of congenital posteromedial bow of tibia. Methods: Seventeen patients were studied using radiographs and medical records retrospectively. The time period was from 1989 to 2002. Data was collected with special reference to
The K2M MESA Rail is a new implant with a unique beam-like design which provides increased rigidity compared with a standard circular rod of equivalent diameter potentially allowing greater control and maintenance of correction. The aim of this study was to review our early experience of this implant. We retrospectively reviewed the case notes and radiographs of all consecutive cases of spinal
We reported the outcomes of patients with Charcot neuropathy who underwent hind foot
Pre-operative planning for limb
Background:. Spinal
Aim:. Recent guidelines have been published by the Association of Neurophysiological Scientists / British Society for Clinical Neurophysiology (ANS/BSCN) regarding the use of intra-operative neurophysiological monitoring (IOM) during spinal deformity procedures. We present our unit's experience with IOM and the compliance with national guidelines. Method:. All patients undergoing intra-operative spinal cord monitoring during adult and paediatric spinal
The implementation of standards for
To determine the effectiveness of six-axis analysis
Introduction. Several hexapod external fixator devices are used in the treatment of bone fracture and
Introduction: It is the accepted dogma that should paralysis complicate spinal
The TL Hex (Orthofix) is a relatively new hexapod frame system that we have been using at our institution since August 2013 to treat acute fractures and correct tibial and femoral deformity. We report our initial experience of 48 completed treatments with this novel system in 46 patients and discuss illustrative cases. For acute fracture, 30 patients (24 male, 7 female) required framing with a mean age of 43 years (range 19–80). One patient underwent bilateral framing. The tibia was involved in all cases. In two cases, the femur also required framing. Open fractures occurred in 13 cases (43.3%). For elective limb reconstruction, 16 patients (14 male, two female) required framing with a mean age of 35 years (range 16–67). One patient underwent bilateral framing. The tibia was involved in all but one case, which affected the femur. Surgical indications included congenital deformity in four cases, malunion in eight cases, non-union in three cases and chronic infection in two cases. For acute fractures, the mean frame time was 164 days (range 63–560) and all but one fracture achieved union. Complications included pin, wire or strut failure requiring adjustment (three patients) and pin site infection (six patients). Three patients are being considered for residual
We report the results of application of a strategy for
Study Design: A prospective observational study of scoliosis patients who were on non-invasive night ventilation for respiratory failure. Objective: To report the results of spinal
Background. Lateral column lengthening combining bony and soft tissue procedures has been described for symptom relief and
Postoperative complication rates remain relatively high after adult spinal deformity (ASD) surgery. The extent to which modifiable patient-related factors influence complication rates in patients with ASD has not been effectively evaluated. The aim of this retrospective cohort study was to evaluate the association between modifiable patient-related factors and complications after corrective surgery for ASD. ASD patients with two-year data were included. Complications were categorized as follows: any complication, major, medical, surgical, major mechanical, major radiological, and reoperation. Modifiable risk factors included smoking, obesity, osteoporosis, alcohol use, depression, psychiatric diagnosis, and hypertension. Patients were stratified by the degree of baseline deformity (low degree of deformity (LowDef)/high degree of deformity (HighDef): below or above 20°) and age (Older/Younger: above or below 65 years). Complication rates were compared for modifiable risk factors in each age/deformity group, using multivariable logistic regression analysis to adjust for confounders.Aims
Methods
Purpose of Study: To observe the efficiency of the combined motor-somatosensory monitoring and somatosensory-alone monitoring to identify the intra-operative neurologic changes. Methods and Results: We retrospectively assessed 123 cases in our centre, who had complete neurophysiological report while undergoing corrective spinal
The concept of guided growth was proposed by Andry in 1741. In the last decades the concept has been widely used as implants has been introduced that can modulate the growth of the bone and pediatric longitudinal and angular deformities is widely treated by this technique. However, there is there is a huge variation in techniques and implants used and high-quality clinical trials is still lacking. Recently implants correcting rotational bony deformities have been proposed and clinical case series have been published. The current status of guided growth will be presented in this narrative review and preliminary experiences with rotational guided growth will be shared. Is guided growth to be considered a safe treatment at this time point?
To evaluate the incidence of complications and the radiographic and clinical outcomes from 2-stage reconstruction including 3-column osteotomy for revision adult spinal deformity. A prospective cohort study performed over 2 years at a major tertiary referral centre for adult spinal
To compare the rates of sagittal and coronal correction for all-pedicle screw instrumentation and hybrid instrumentation using sublaminar bands in the treatment of thoracic adolescent idiopathic scoliosis (AIS). We retrospectively reviewed the medical records of 124 patients who had undergone surgery in two centres for the correction of Lenke 1 or 2 AIS. Radiological evaluation was carried out preoperatively, in the early postoperative phase, and at two-year follow-up. Parameters measured included coronal Cobb angles and thoracic kyphosis. Postoperative alignment was compared after matching the cohorts by preoperative coronal Cobb angle, thoracic kyphosis, lumbar lordosis, and pelvic incidence.Aims
Methods
Objective. The use of all pedicle screw constructs for the management of spinal deformities has gained widespread popularity. However, the placement of pedicle screws in the deformed spine poses unique challenges for the spinal surgeon. The purpose of this study was to evaluate the complications and radiological outcomes of surgery in 124 consecutive patients with spinal deformity. These patients underwent correction of coronal and sagittal imbalance with segmental pedicle screw fixation only. Background. All pedicle screw constructs have been associated with improved correction in all three planes. In patients with severe deformity, such constructs can obviate the need for anterior surgeries, and the higher implant cost is offset by the avoidance of dual anterior and posterior approaches. Pedicle screw fixation enables enhanced correction of spinal deformities, but the technique is still not widely applied for thoracic deformities for fear of neurological complications. This is a retrospective study that was carried out on 124 patients who underwent segmental screw fixation for coronal and sagittal spinal deformities. The purpose of this study was to evaluate the complications and outcomes of this technique and also assess the evidence of enhanced correction. Material and Methods. A total of 124 consecutive patients subjected to pedicle screw fixation for spinal deformities were analysed after a minimum period of follow-up of two years. Etiologic diagnoses were idiopathic scoliosis in 32, neuromuscular scoliosis 48, Scheuermann's kyphosis in 28 and others 16. They were reviewed using the medical records and preoperative, intraoperative and postoperative radiographs. Computed tomography was performed when screw position was questionable.
The aim of our study was to assess the efficacy and complications of treatment of limb deformities using six axes deformity analysis and the Taylor TM Spatial Frame [TSF]. Between January 1997 and March 2000, we treated 75 lower limbs in 66 patients with deformities. Patients were divided into four groups. The groups were Blount’s disease, congenital deformities, traumatic deformities, and a miscellaneous group. The data was prospectively collected. This was a consecutive series of the first 66 patients treated at our institution with the TSF.
Objective To assess the validity of Somatosensory Evoked Potential (SSEP) monitoring in identifying potential spinal cord vascular damage resulting from segmental artery ligation in anterior spinal
Introduction Transcranial motor evoked potentials are routinely used at The Children’s Hospital at Westmead to monitor the spinal cord in spinal surgery. This study is a prospective review of all spinal cord monitoring procedures from 1999 to 2004 in patients undergoing elective spinal
Purpose: Methods: Evaluation of the results of arthroscopic ankle arthrodesis, performed in 49 consecutive patients (52 ankles), with disabling ankle arthritis, between 08/1998 and 12/2004. Thirty ankles had no significant deformity (group A), whereas 22 ankles had a varus or valgus deformity greater than 10° (mean 21.7°, max 45°) (group B). Mean age in groups A and B was 49.7 and 57.5 years respectively (p=0.15). The primary diagnosis in groups A and B was post-traumatic arthritis in 66% and 27% and idiopathic osteoarthritis in 17% and 59%, respectively. Average hospital stay was 3.63 and 3.68 days in groups A and B respectively (p=0.96). Postoperative treatment included ankle immobilization for 3 months. Progressive weight-bearing was initiated at two weeks. Mean follow-up was 14.9 months (range 6–60). Results: No infections or neurovascular problems occurred. Fusion occurred in 29/30 cases in group A at an average time of 11.52±5.2 weeks and in 21/22 patients at 11.67±2.3 weeks in group B (p=0.89). Not planned surgical procedures were required in eight cases (15.4%). Symptomatic arthritis from the adjacent joints developed in three cases during the follow-up period. The arthrodesis position angle measured in the sagittal plane from the lateral post-operative plane film averaged 105°±3° and 103°±6° in groups A and B respectively (p=0.27). The outcome in groups A and B was graded as very good in 73% and 72.7%, fair in 23% and 22.7% and poor in one case in each group, respectively (p=0.26). Conclusions: The arthroscopic technique offers a high fusion rate, decreased time to fusion, short hospital stay and absence of limb-threatening complications.
Complex spinal deformities can cause pain, neurological symptoms and imbalance (sagittal and/or coronal), severely impairing patients’ quality of life and causing disability. Their treatment has always represented a tough challenge: prior to the introduction of modern internal fixation systems, the only option was an arthrodesis to prevent worsening of the deformity. Then, the introduction of pedicle screws allowed the surgeons to perform powerful corrective manoeuvres, distributing forces over multiple levels, to which eventually associate osteotomies. In treating flexible coronal deformities, in-ternal fixation and corrective manoeuvres may be sufficient: the combination of high density pedicle screws and direct vertebral rotation revolutionized surgical treatment of scoliosis. However, spinal osteotomies are needed for correcting complex rigid deformities; the type of osteot-omy must be chosen according to the aetiology, type and apex of the deformity. When dealing with large radius deformities, spread over multiple levels and without fusion, multiple posterior column os-teotomies such as Smith-Petersen and Ponte (asymmetric, when treating scoliosis) can be performed, dissipating the correction over many levels. Conversely, the management of a sharp, angulated de-formity that involves a few vertebral levels and/or with bony fusion, requires more aggressive 3 col-umn osteotomies such as Pedicle Subtraction Osteotomies (PSO), Bone Disc Bone Osteotomies (BDBO) or Vertebral Column Resection (VCR). Sometimes the deformity is so severe that cannot be corrected with only one osteotomy: in this scenario, multilevel osteotomies can be performed.
Introduction: Complications of homologous blood transfusion include transmission of infection and development of antibodies. Autologous pre-donation, acute normo-volaemic haemodilution and cell salvage have been used to reduce the use of homologous transfusions. Surgery for spinal deformities often requires blood transfusion. In February 1999, we started an autologous pre-donation programme for children undergoing spinal
Coronal malalignment and leg length discrepancies (LLD) are frequently associated. Temporary hemiepiphysiodesis (tHED) is commonly employed for the correction of limb malalignment in skeletally immature patients. For treatment of LLD greater than 2 cm, lengthening with intramedullary legnthening nails is a safe and reliable technique. However, the combined application of these approaches in skeletally immature patients has not yet been investigated. Retrospective radiological and clinical analysis of 25 patients (14 females, 11 males) who underwent intramedullary femoral lengthening with an antegrade PRECICE® lengthening nail as well as tHED of the distal femur and / or proximal tibia between 2014 and 2019. tHED was conducted by implantation of flexible staples (FlexTack™) either prior (n = 11), simultaneously (n = 10), or subsequently (n = 4) to femoral lengthening. The mean follow-up period was 3.7 years (±1.4).Introduction
Materials & Methods
Retrospective review of blood loss during posterior instrumented fusion in Adult
Purpose: Despite advances in surgical technique, neurological injury remains a potentially devastating complication of spinal
There is a wide range of reports on the prevalence of neurological injuries during scoliosis surgery, however this should depend on the subtypes and severity of the deformity. Furthermore, anterior versus posterior corrections pose different stresses to the spine, further quantifications of neurological risks are presented. Neuromonitoring data was prospectively entered, and the database between 2006 and 2012 was interrogated. All deformity cases under the age of 21 were included. Tumour, fracture, infection and revision cases were excluded. All “red alerts” were identified and detailed examinations of the neuromonitoring records, clinical notes and radiographs were made. Diagnosis, deformity severity and operative details were recorded. 2290 deformity operations were performed: 2068 scoliosis (1636 idiopathic, 204 neuromuscular, 216 syndromic, and 12 others), 89 kyphosis, 54 growing rod procedures, and 80 operations for hemivertebra. 696 anterior and 1363 posterior operations were performed for scoliosis (8 not recorded), and 38 anterior and 51 posterior kyphosis correction. 67 “red alerts” were identified, there were 14 transient and 6 permanent neurological injuries. 62 were during posterior stage (24 idiopathic, 21 neuromuscular, 15 syndromic (2 kyphosis), 1 growing rod procedure, 1 haemivertebra), and 5 were during anterior stage (4 idiopathic scoliosis and 1 syndromic kyphosis). Average Cobb angle was 88°. 1 permanent injuries were during correction for kyphosis, and 5 were for scoliosis (4 syndromic, 1 neuromuscular, and 1 anterior idiopathic). Common reactions after “red alerts” were surgical pause with anaesthetic interventions (n=39) and the Stagnara wake-up test (n=22). Metalwork was partially removed in 20, revised in 12 and completely removed in 9. 13 procedures were abandoned. The overall risk of permanent neurological injuries was 0.2%, the highest risk groups were posterior corrections for kyphosis and scoliosis associated with a syndrome. 4% of all posterior
The Orthofix acute correction template has been developed for multiplanar
Introduction: The Taylor Spatial Frame (TSF) is a circular external fixator based on a hexapod system consisting of two carbon fiber rings connected with six telescopic struts. In conjunction with a software program the TSF allows for correction of deformities in 6 axis. After completion of the computer generated distraction plan a residual program can be used to correct any residual malalignment. Although the TSF received marketing clearance in 1997 and is used in specialized centers around the world, there is, up to date, only one MEDLINE report of two cases treated with the TSF. We present the results of 48 cases of limb lengthening and/or
The aim of this study was to determine the effectiveness of intra-operative tranexamic acid in children with osteogenesis imperfecta, who have been shown to have increased bleeding tendency, in
Introduction. Surgical correction of spinal deformities is a challenge; segmental instrumentation controlling almost every level is the most recent approach. Correction of the deformity only through apical manipulation has many potential advantages, including little tissue disruption, less invasive intervention, preservation of spinal mobility, and vertebral growth. However, quantification of the amount of force needed to pull on the apex and its effect on translation, de-rotation, and overall correction of the curve needs to be studied. The purpose of this study is to determine the effect and amount of force needed to pull on the apex of a scoliotic deformity towards the midline, and the feasibility of use of this novel potential method of correction in the treatment of patients with adolescent idiopathic scoliosis (AIS). Methods. Measurements were taken from 20 patients with AIS treated between June, 2009, and January, 2010. There were 16 female and 4 male patients with an average age of 14.2 years (range 11–20); the coronal preoperative Cobb angle was 67° (42–108°), decreasing on bending to 39° (8–83°), and the apex of the deformity was between T6 and L2. All patients had proximal and distal anchors spanning two levels on each end; the anchors were connected by a concave rod to which the apical vertebra was pulled. We measured the distance between the rod and the apical vertebra and the rotation of the apical vertebrae. Results. In 17 patients a force of 30 lb was applied and in 14 patients the force reached 40 lb. The apical baseline distance was 20.9 mm (10–40); at 30 lb of pull it decreased to 11.9 mm (0–27) and at 40 lb it was 9.4 mm (0–23) or 55% translation. The change in apical rotation was measured in 12 patients. The apex de-rotated in 10 of 12 patients, with a mean rotation of 5.2° (2–10°). Conclusions. Apical translation, vertebral de-rotation, and scoliosis correction can be done by application of a force pulling on a convex anchor at the apex of the curve towards a concave rod. With suitable instrumentation,