Aims. Closed suction subfascial drainage is widely used after instrumented
Clinical, radiological, and Scoliosis Research
Society-22 questionnaire data were reviewed pre-operatively and
two years post-operatively for patients with thoracolumbar/lumbar
adolescent idiopathic scoliosis treated by posterior spinal fusion
using a unilateral convex segmental pedicle screw technique. A total
of 72 patients were included (67 female, 5 male; mean age at surgery
16.7 years (13 to 23)) and divided into groups: group 1 included
53 patients who underwent fusion between the vertebrae at the limit
of the curve (proximal and distal end vertebrae); group 2 included
19 patients who underwent extension of the fusion distally beyond
the caudal end vertebra. A mean scoliosis correction of 80% (45% to 100%) was achieved.
The mean post-operative lowest instrumented vertebra angle, apical
vertebra translation and trunk shift were less than in previous
studies. A total of five pre-operative radiological parameters differed
significantly between the groups and correlated with the extension
of the fusion distally: the size of the thoracolumbar/lumbar curve,
the lowest instrumented vertebra angle, apical vertebra translation,
the Cobb angle on lumbar convex bending and the size of the compensatory
thoracic curve. Regression analysis allowed an equation incorporating
these parameters to be developed which had a positive predictive
value of 81% in determining whether the lowest instrumented vertebra
should be at the caudal end vertebra or one or two levels more distal.
There were no differences in the Scoliosis Research Society-22 outcome
scores between the two groups (p = 0.17). In conclusion, thoracolumbar/lumbar curves in patients with adolescent
idiopathic scoliosis may be effectively treated by posterior spinal
fusion using a unilateral segmental pedicle screw technique. Five
radiological parameters correlate with the need for distal extension
of the fusion, and an equation incorporating these parameters reliably
informs selection of the lowest instrumented vertebra. Cite this article:
Aims. Historically, patients undergoing surgery for adolescent idiopathic scoliosis (AIS) have been nursed postoperatively in a critical care (CC) setting because of the challenges posed by prone positioning, extensive exposures, prolonged operating times, significant blood loss, major intraoperative fluid shifts, cardiopulmonary complications, and difficulty in postoperative pain management. The primary aim of this paper was to determine whether a scoring system, which uses Cobb angle, forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and number of levels to be fused, is a valid method of predicting the need for postoperative critical care in AIS patients who are to undergo scoliosis correction with
Background: context: Length of hospital stay (LOS) varies widely within patients with
Aims. In a multicentre, randomised study of adolescents undergoing
posterior spinal fusion for idiopathic scoliosis, we investigated
the effect of adding gelatine matrix with human thrombin to the
standard surgical methods of controlling blood loss. Patients and Methods. Patients in the intervention group (n = 30) were randomised to
receive a minimum of two and a maximum of four units of gelatine
matrix with thrombin in addition to conventional surgical methods
of achieving haemostasis. Only conventional surgical methods were
used in the control group (n = 30). We measured the intra-operative
and total blood loss (intra-operative blood loss plus post-operative
drain output). Results. Each additional hour of operating time increased the intra-operative
blood loss by 356.9 ml (p <
0.001) and the total blood loss by
430.5 ml (p <
0.001). Multiple linear regression analysis showed
that the intervention significantly decreased the intra-operative
(-171 ml, p = 0.025) and total blood loss (-177 ml, p = 0.027).
The decrease in haemoglobin concentration from the day before the
operation to the second post-operative day was significantly smaller
in the intervention group (-6 g/l, p = 0.013) than in the control
group. . Conclusion. The addition of gelatine matrix with human thrombin to conventional
methods of achieving haemostasis reduces both the intra-operative
blood loss and the decrease in haemoglobin concentration post-operatively
in adolescents undergoing
1. Four out of five patients with spondylolisthesis, four-fifths of whom were seen at least five years after operation, had their symptoms relieved after
Introduction: Dural tears are one of the most frequent type of complication in
1. The results of
Introduction. There are controversies in the literature about thoracoplasty and its effect on lung function changes. The aim of the study was to evaluate the effect and outcome of thoracoplasty in conjunction with pedicle screw construct in the treatment of thoracic adolescent idiopathic scoliosis on lung functions. Materials and methods. It is a retrospective study of consecutive series of 62 patients with thoracic adolescent idiopathic scoliosis surgically treated by single surgeon between 2007 and 2008 at a tertiary referral Orthopaedic Spinal unit.
Fractures and fracture dislocations involving the lower lumbar spine and lumbosacral junction are uncommon. These high velocity injuries are often associated with neurological deficit, incontinence and dural tears. The accepted treatment has been posterior stabilisation with fusion, but loss of reduction has often been reported. We reviewed our experience over the past four years in the management of eight male patients, two of whom sustained injuries in motor vehicle accidents and two in falls from a height. Two patients had L5/S1 traumatic spondylo-listhesis with no neurological deficit. Of the six patients with fracture dislocations of L3/4, four had translation in the sagittal and coronal planes and incomplete neurological deficit. Associated injuries in four patients included an ankle fracture, multiple rib fractures, dislocation of knee and hip, and a fracture dislocation of the midfoot. Following satisfactory reduction, seven patients were treated by
Proponents of thoracoplasty suggest a better correction, obviating iliac crest donor site morbidity, obtaining bone grafts for fusion and better rib hump correction. Opponents suggest increase risk for chest complications, additional operating time and blood loss, and possible longer hospital stay. There are controversies in the literature about thoracoplasty and its effect on lung function changes. The aim of the study was to evaluate the effect and outcome of thoracoplasty in conjunction with pedicle screw construct in the treatment of thoracic adolescent idiopathic scoliosis on lung functions. It is a retrospective study of consecutive series of 62 patients with thoracic adolescent idiopathic scoliosis surgically treated by single surgeon between 2007 and 2008 at a tertiary referral Orthopaedic Spinal unit.
Introduction: This is a retrospective study of the effectiveness of Amicar in decreasing perioperative blood loss and the need for transfusion in same-day anterior (ASF) and
The current study aims to compare the clinico radiological outcomes between Non-Fusion Anterior Scoliosis (NFASC) Correction and
Purpose: Postoperative pain is common following
Purpose: A retrospective study comparing the fusion rate and, the incidence of junctional spinal stenosis between a rigid (Wiltse) and a semirigid (Varifix)
We studied 29 girls and one boy with adolescent idiopathic scoliosis who were at Risser grade 0 at the time of
Background:. Long-Term Follow-Up Of Lung Function And Quality Of Life (Qol) In Those Undergoing Combined Anterior And
A 14 year-old-female, underwent a T3-L3 instrumented
To present the results of surgical correction in patients with double or triple thoracic/lumbar AIS (Lenke types 2,3,4) with the use of a novel convex/convex unilateral segmental screw correction technique in a single surgeon's prospective series. We reviewed the medical records and spinal radiographs of 92 consecutive patients (72 female-20 male). We measured scoliosis, thoracic kyphosis, lumbar lordosis, scoliosis flexibility and correction index, coronal and sagittal balance before and after surgery, as well as at minimum 2-year follow-up. SRS-22 data was available preoperatively, 6-month, 12-month and 2-year postoperatively for all patients. Surgical technique. All patients underwent
We present the results of correcting a double or triple curve
adolescent idiopathic scoliosis using a convex segmental pedicle
screw technique. We reviewed 191 patients with a mean age at surgery of 15 years
(11 to 23.3). Pedicle screws were placed at the convexity of each
curve. Concave screws were inserted at one or two cephalad levels
and two caudal levels. The mean operating time was 183 minutes (132
to 276) and the mean blood loss 0.22% of the total blood volume
(0.08% to 0.4%). Multimodal monitoring remained stable throughout
the operation. The mean hospital stay was 6.8 days (5 to 15).Aims
Patients and Methods