Conventional growing rods are the most commonly
used distraction-based devices in the treatment of progressive early-onset
scoliosis. This technique requires repeated lengthenings with the
patient anaesthetised in the operating theatre. We describe the
outcomes and complications of using a non-invasive magnetically
controlled growing rod (MCGR) in children with early-onset scoliosis.
Lengthening is performed on an outpatient basis using an external remote
control with the patient awake. Between November 2009 and March 2011, 34 children with a mean
age of eight years (5 to 12) underwent treatment. The mean length
of follow-up was 15 months (12 to 18). In total, 22 children were
treated with dual rod constructs and 12 with a single rod. The mean
number of distractions per patient was 4.8 (3 to 6). The mean pre-operative
Cobb angle was 69° (46° to 108°); this was corrected to a mean 47°
(28° to 91°) post-operatively. The mean Cobb angle at final review
was 41° (27° to 86°). The mean pre-operative distance from T1 to
S1 was 304 mm (243 to 380) and increased to 335 mm (253 to 400)
in the immediate post-operative period. At final review the mean distance
from T1 to S1 had increased to 348 mm (260 to 420). Two patients developed a superficial wound infection and a further
two patients in the single rod group developed a loss of distraction.
In the dual rod group, one patient had pull-out of a hook and one
developed prominent metalwork. Two patients had a rod breakage;
one patient in the single rod group and one patient in the dual
rod group. Our early results show that the MCGR is safe and effective
in the treatment of progressive early-onset scoliosis with the avoidance
of repeated surgical lengthenings. Cite this article:
Spinal deformities are a common feature of Marfan’s syndrome and can be a significant cause of morbidity. The morphology of the scoliosis associated with this condition was previously described by Sponseller, but no correlation with the pelvic parameters has been seen. We performed a retrospective radiological study of 58 patients with scoliosis, secondary to Marfan’s syndrome and related the findings in the thoracolumbar spine to the pelvic parameters, including pelvic version (tilt), pelvic incidence and sacral slope. Our results showed marked abnormalities in the pelvic values compared with those found in the unaffected population, with increased retroversion of the pelvis in particular. In addition we found a close correlation between the different patterns of pelvic parameters and scoliosis morphology. We found that pelvic abnormalities may partially dictate the spinal disorders seen in Marfan’s syndrome. Our results supplement the well-established Sponseller classification, as well as stressing the importance of considering the orientation of the pelvis when planning surgery.
The objective of this study was to assess the association between whole body sagittal balance and risk of falls in elderly patients who have sought treatment for back pain. Balanced spinal sagittal alignment is known to be important for the prevention of falls. However, spinal sagittal imbalance can be markedly compensated by the lower extremities, and whole body sagittal balance including the lower extremities should be assessed to evaluate actual imbalances related to falls. Patients over 70 years old who visited an outpatient clinic for back pain treatment and underwent a standing whole-body radiograph were enrolled. Falls were prospectively assessed for 12 months using a monthly fall diary, and patients were divided into fallers and non-fallers according to the history of falls. Radiological parameters from whole-body radiographs and clinical data were compared between the two groups.Objectives
Methods
The October 2012 Children’s orthopaedics Roundup360 looks at: magnetic growing rods and scoliosis correction; maintaining alignment after manipulation of a radial shaft fracture; Glaswegian children and swellings of obscure origin; long-term outcome of femoral derotation osteotomy in cerebral palsy; lower-leg fractures and compartment syndrome in children; fractures of the radial neck in children; management of the paediatric Monteggia fracture; and missing the dislocated hip in Western Australia.
The management of joint replacement in lysosomal storage diseases has not been well reported. We present three patients with progressive degenerative changes of the hips who required bilateral total hip replacement in early childhood. The stature of the patients make it essential to have access to appropriately scaled prostheses. Consideration has to be given to associated disorders of the skeleton which must be carefully screened to ensure safety in providing appropriate anaesthesia as well as ensuring that there is no cardiac abnormality. In one patient, a periprosthetic fracture was sustained in one hip in the early post-operative course requiring internal fixation. The patient made a full recovery and all six hips were clinically and radiologically satisfactory at mid-term review.
