Surgical treatment of segmental spinal dysgenesis: a report of 19 cases (original) (raw)
Related papers
Segmental Spinal Dysgenesis–“Redefined”
Asian Spine Journal
Retrospective single institutional observational study. Purpose: Segmental spinal dysgenesis (SSD), a complex spinal dysraphic state caused by notochord malformation disorders, is named after its morphological presentation where a spine segment is dysgenetic, malformed or absent. This study's objective was to examine and reassess SSD imaging findings and correlate them with an embryological explanation. Overview of Literature: Scott and his colleagues defined SSD as segmental agenesis or dysgenesis of the lumbar or thoracolumbar vertebrae and underlying spinal cord. Tortori-Donati and his colleagues defined it as a morphologic continuum ranging from hypoplasia to an absent spinal cord segment. Methods: Fifteen children, whose imaging findings and clinical features were consistent with SSD, were included in the study. Magnetic resonance imaging (MRI) was performed per institutional spine protocol. Results: Five children (33.3%) presented with a high-ending bulbous cord with no caudal segment, six (40%) presented with a dorsal or lumbar segmental dysgenetic cord with a low-lying, bulky caudal cord but without significant spinal canal narrowing, and four (26.6%) presented with segmental caudal dysgenesis with severe kyphoscoliosis, gibbus deformity, and spinal canal narrowing with a normal distal segment (normal or low-lying). Conclusions: SSD is a complex spinal anomaly in children requiring clinical-radiological assessment followed by multidisciplinary management based on the extent and severity of the dysgenetic cord and the type of SSD. MRI plays a crucial role in both diagnosing and classifying SSD prior to surgical treatment to prevent further impairment.
Degenerative lumbar scoliosis: features and surgical treatment
Journal of Orthopaedics and Traumatology, 2006
Degenerative lumbar scoliosis is a de novo deformity of the spine occurring after the fourth or fifth decade of life in patients with no history of scoliosis in the growing age. We evaluated complications and functional and radiographic outcomes of twelve patients with degenerative lumbar scoliosis, treated by spinal decompression associated with posterolateral and/or interbody fusion. Mean lumbar scoliosis angle was 18°( SD=4°) and mean age at surgery was 57 years (SD=6 years). Average follow-up was 3.5 years. Surgical treatment consisted in decompression of one or more roots, associated with stabilization with pedicle screws and posterolateral fusion. To correct the deformity, the collapse of the disc was cor-rected by implanting a cage in the anterior interbody space. Clinical symptoms and functional tolerance for daily activities improved after surgery. Radiographic evaluation showed a reduction in the deformity on the frontal and sagittal planes. There were no infections, evidence of pseudoarthrosis, instrumentrelated failures or re-operations in this series. In patients with persisting pain caused by degenerative scoliosis associated with spinal stenosis, in whom conservative treatment has failed, spinal decompression and segmented fusion with instrumentation represents a valid treatment option.
European Spine Journal, 2014
Background Lumbar and thoracolumbar deformity in the adult is a condition with impairment of health status that can need surgical treatment. In contrast with adolescent deformity, where magnitude of the curve plays a significant role in surgical indication, the aspects relevant in adult deformity are pain and dysfunction that correlate with segment degeneration and imbalance. Previous classifications of adult deformity have been of little use for surgical planning. Methods Chart review and classification of radiographic and clinical findings. A classification of degenerative disc disease based on distribution of diseased segments and balance status of the spine is presented. Results Four main categories are presented: Type I (limited nonapical segment disease), Type II (limited apical segment disease), Type III (extended segment disease-apical and nonapical), Type IV (imbalanced spine: IVa, sagittally imbalanced; IVb, sagittally and coronally imbalanced). Discussion and conclusion Types I and II can be treated by fusion of a selective area of the curve. Type III needs fusion of all the extension of the coronal curve. Type IV usually needs aggressive corrective procedures, frequently including posterior tricolumnar osteotomies. This classification permits interpreting the extension and magnitude of the disease and can help establish a surgical plan regarding selective fusion and methods of sagittal correction. Future research is needed to validate the classification.
Surgical Disorders of the Thoracic and Lumbar Spine: A Guide for Neurologists
Journal of Neurology, Neurosurgery & Psychiatry, 2002
Degenerative and pathological disorders of the thoracolumbar spine may present with symptoms which warrant further evaluation by a neurologist. This article aims to provide an overview of the typical presentation and standard management of various thoracolumbar spinal disorders and includes information that is intended to facilitate the investigative and diagnostic process. Mixter and Barr in 1934 first described the herniated disc to be a cause of segmental leg pain (sciatica or femoralgia). Acute low back pain is a relatively common condition and is accompanied by sciatica in only 1–2% of cases. Patients presenting with acute low back pain alone are therefore unlikely to have a disc prolapse. Lumbar intervertebral disc prolapse is most prevalent between the ages of 30–50 years, and the L5/S1 and L4/5 intervertebral discs account for 95% of all lumbar prolapses. A lumbar disc prolapse typically presents with gradual or sudden onset localised back pain radiating through the buttock ...
Abstracts of the 22nd National Congress on Spinal Surgery
European Spine Journal, 2008
Aim: Review the incidence of thoracogenic scoliosis in a third-level pediatric hospital. Materials and Methods: The medical records and radiographs of 519 patients undergoing posterolateral thoracotomy from 1990 to 2005 were reviewed. Forty-three patients required consultation with a pediatric orthopedist for scoliosis. None of these patients had a scoliotic curve of 10°or more before thoracotomy; patients with scoliosis secondary to rib fusion associated with vertebral anomalies were excluded. Anteroposterior and lateral X-rays were reviewed to assess Risser stage, measure Cobb angle, and determine the morphology of the curve in relation to the thoracotomy side, number of complications, underlying pathology, and the orthopedic and surgical treatment applied. Five patients required surgical treatment. The indications for thoracotomy included esophageal atresia (3), persistent ductus arteriosus (1) and tumor of the chest wall (1). Mean age of the patients undergoing scoliosis surgery was 10 years (4-15). Results: Mean latency time from thoracotomy to the consultation for scoliosis was 4 years and 3 months. Curve angles were 108-20°i n 21 patients, 208-308 in 15, 308-408 in 3, and greater than 408 in four. Patients classified as Risser 0,1, or 2 with curves greater than 258 were monitored with braces. Radiologic measurement of the major Cobb angle yielded 54.28 (328-718) preoperatively and 34.28 (228-488) following surgery. Two instrumented posterior fusions were performed, and three vertical expandable prosthetic titanium rib (VEPTR) devices were implanted, allowing expansion with growth. Conclusions:
Anterior Spinal Fusion for Thoracolumbar Scoliosis
Journal of Pediatric Orthopaedics, 2010
Background: There is a continued role for anterior spinal fusion (ASF) in the treatment of thoracolumbar scoliosis. Despite numerous previous reports of ASF in the treatment of thoracolumbar scoliosis, no single study has simultaneously evaluated clinical, radiographic, and pulmonary function outcomes. Methods: Retrospective review of 31 consecutive thoracolumbar adolescent idiopathic scoliosis patients (Lenke type 5) who underwent ASF by a single surgeon. Patient records were comprehensively assessed for Scoliosis Research Society (SRS)-22 score, apical trunk rotation, radiographic changes, and pulmonary function before surgery and at 2-years follow-up. Results: Thoracolumbar/lumbar curve correction averaged from 45 to 11 degrees (74%) and spontaneous correction of thoracic curves averaged from 26 to 15 degrees (42%). Instrumented segment lordosis increased by 11 degrees, whereas proximal junction kyphosis increased by 3 degrees. No significant changes were noted in T2-T12 kyphosis, distal junctional kyphosis, T12-S1 lumbar lordosis, or coronal balance. Thoracolumbar apical trunk rotation improved from 12 to 3 degrees. Average SRS scores significantly improved from 3.9 to 4.4. SRS assessments of self-image and pain also improved significantly from 3.6 to 4.5 and from 4.1 to 4.6, respectively. Absolute and percent predicted forced vital capacity and forced expiratory volume in 1 second were unchanged. Two patients suffered mild intercostal neuralgia postthoracotomy. There were no other complications. Conclusions: The thoracoabdominal anterior approach for thoracolumbar scoliosis facilitates excellent clinical and radiographic outcomes, minimal blood loss, powerful apical trunk rotation correction, relative maintenance of lordosis, relatively short fusion constructs, and improved SRS-22 performance, without significant pulmonary function impairment at 2 years. It continues to be an efficacious treatment for thoracolumbar scoliosis. Level of Evidence: Level IV.
European Spine Journal, 1993
Les résultats obtenus chez 23 patients présentant une spondylolyse symptomatique ou un spondylolisthésis isthmique discret et traités par la méthode de reconstruction isthmique de Scott, ont été analysés en portant une attention particulière à la mobilité rachidienne et à l'état des disques intervertébraux. Ils ont été comparés aux résultats obtenus chez 25 autres patients traités par greffe segmentaire postéro-latérale sans instrumentation. Les deux groupes étaient comparables quant à l'âge au moment de l'opération (17.4 ans ±5.7 contre 15.6±2.6), à la durée du suivi postopératoire (54±8 mois contre 54±25), au sexe, et aux signes subjectifs préopératoires. Le glissement vertébral préopératoire moyen était plus élevé dans le groupe qui a été fusionné (7.2 mm ±8.4 contre 13.1±4, P=0.003). L'évaluation des suites a été réalisée par un observateur indépendant. Elle a comporté une entrevue, le questionnaire Oswestry, la représentation de la douleur sur une échelle d'intensité, l'examen physique, des radiographies standard, une IRM et un testing fonctionnel (mobilité du rachis lombaire, force de soulèvement statique). Pour l'analyse statistique on a utilisé le t-test de Student, le test du chi-2, et le t-test apparié. Lors du suivi, 87% du groupe S (Scott) et 96% du groupe F (fusion) présentaient des douleurs occasionnelles, sans incidence sur les activités quotidiennes, ou pas de douleurs du tout. Il n'y avait pas de différence statistique dans les résultats subjectifs, cliniques ou fonctionnels, entre les deux groupes de patients opérés. Les radiographies standard montraient dans les deux groupes une perte significative de la hauteur discale du segment opéré lors du suivi, indiquant la progression post-opératoire de la dégénérescence discale. Sur les radio-graphies en flexion/extension, l'amplitude totale du mouvement dans les trois derniers segments lombaires était un peu plus importante après reconstruction. Cette différence n'était pas significative. Sur les IRM il n'y avait pas de différence statistique de l'index d'hydratation discale entre les deux groupes. L'état du disque situé au dessus de la fusion n'était pas plus mauvais par rapport aux disques correspondants situés au-dessus de la reconstruction. Il n'y avait pas de corrélation entre les signes discaux pathologiques à l'IRM et le résultat clinique obtenu. Il est conclu que dans un petit groupe de jeunes patients, les résultats précoces sont satisfaisants dans la majorité des cas après la reconstruction de la lyse aussi bien qu'après la fusion segmentaire. Au point actuel de la surveillance postopératoire il est impossible de préciser lequel des deux procédés devrait être préféré pour le traitement opératoire de ces situations chez les patients jeunes. La réparation directe des isthmes ne protège pas le disque du segment lytique/olisthésique d'une dégénérescence ultérieure. Les modifications pathologiques du disque à l'IRM devraient être interprétées avec précaution parce que leur valeur clinique n'est pas encore clairement établie. The results of 23 patients with symptomatic spondylolysis or mild isthmic spondylolisthesis treated by Scott's direct repair of the defect (secclusion) were analyzed with particular reference to spinal mobility and the condition of the intervertebral discs, and compared with the outcome of 25 patients treated by posterolateral segmental fusion without instrumentation. The two groups were comparable as to age at operation (17.4±5.7 vs. 15.6±2.6 years), follow-up time (54±8 vs. 54±25 months), gender, and preoperative subjective symptoms. The mean preoperative vertebral slip was greater in the fusion group (7.2±8.4 vs. 13.1±4, P=0.003). The follow-up assessment was carried out by an independent observer. It included an interview, Oswestry questionnaire, pain scale drawing, physical examination, plain radiographs, magnetic resonance imaging (MRI), and functional testing (lumbar spine mobility, static lifting power). For statistical analysis, the Student's t-test, the x2 test, and the paired t-test were used. At follow-up, 87% of the Scott's group and 96% of the fusion group had occasional pain, not interfering with daily activities, or no pain at all. There was no statistical difference in the subjective, clinical, or functional outcome between the two operation groups. Plain radiographs in both groups showed significant loss of disc height in the operated segment during follow-up, indicating post-operative progression of disc degeneration. In flexion/extension radiographs the total range of movement in the three lowermost lumbar segments was slightly greater after secclusion. This difference was not significant. In MRI there was no statistical difference in disc hydration index between the two groups. The condition of the disc above the fusion was not worse than that of the corresponding disc above the secclusion. There was no correlation between pathologic disc findings in MRI and clinical outcome. It is concluded that in a small group of young patients the early results both after direct repair of the defect and after segmental fusion are satisfactory in the majority of cases. At this point of follow-up it is impossible to say which of the two procedures should be preferred for operative treatment of this condition in young patients. Direct repair does not protect the disc of the lytic/olisthetic segment from further degeneration. Pathologic disc changes in MRI should be interpreted with caution because their clinical relevance is still unclear.
Objective: Scoliosis with associated intraspinal anomalies may be treated either before the correction of spinal deformities or during the same session. Our study elucidates the impact of the timing of single-or two-stage neurosurgical and deformity treatment of intraspinal pathologies with the outcomes of serious spinal deformities and discusses the preferable method. Methods: Patients who were operated either concurrently or in two stages, due to intraspinal anomalies associated with rigid spinal deformities, were radiologically and clinically examined. Patients' ages during the neurosurgical treatment and at the time of deformity treatment, period between two surgeries, follow-up period, clinical and radiological results and encountered complications were recorded. Results: Nineteen patients (13 females, 6 males) underwent surgery for spinal deformities associated with intraspinal pathologies between 2007 and 2014. Fifteen (78.9%) patients underwent a two-stage surgery and four (21.1%) patients' concurrent surgeries. Mean age of the patients at the time of intraspinal pathology surgery was 8.6 ± 6.9 years and at posterior spinal fusion (PSF) 13.4 ± 3.9 years. The period between the two surgeries was 54.2 ± 67.5 months on average and the mean follow-up period was 39.8 ± 22.2 months. The anteroposterior Cobb's angle was measured as 68.2° ± 27.1° preoperatively and 29.1° ± 18.7° at final examination (p=0.00). Visual analog scale score was 8.1 ± 1 preoperatively and 1.1 ± 0.2 at the final follow-up (p=0.00). Conclusion: The etiology, extent of deformity, curve progression and patient's age were indicative in the surgical treatment of intraspinal pathologies and spinal curves. Concurrent surgical interventions may be recommended to avoid additional complications and for quicker recovery.