Strategies in the pediatric spine:
Gespeichert in:
| Format: | Buch |
|---|---|
| Sprache: | English |
| Veröffentlicht: |
Philadelphia
Hanley & Belfus
2000
|
| Schriftenreihe: | Spine
14,1 |
| Schlagworte: | |
| Online-Zugang: | Inhaltsverzeichnis |
| Beschreibung: | XIX, 298 S. zahlr. Ill., graph. Darst. |
| ISBN: | 1560533323 |
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Datensatz im Suchindex
| _version_ | 1804127767963369472 |
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| adam_text | SPINE: State of the Art Reviews
Vol. 14, No. 1, 2000
Strategies in the Pediatric Spine
Denis S. Drummond, MD, Editor
CONTENTS
Preface xix
Denis S. Drummond
Etiology of Adolescent Idiopathic Scoliosis 1
Michael Edgar, Thomas G. Lowe, Joseph Y. Margulies, Nancy H. Miller,
V. James Raso, and Kent A. Reinker
Identifying the etiology of idiopathic scoliosis remains a work in progress. It ap¬
pears that a complex and probably multifactorial process is involved. This chapter
discusses the leading etiologic possibilities and outlines the current state of our
understanding of these possibilities. Interestingly, naturally occurring scoliosis in
vertebrates is almost exclusively seen in humans. It appears that some form of
central defect in spinal growth control occurs and that this in turn creates a suscep¬
tibility in the growing spine to develop a deformity in particular individuals. A ge¬
netic aspect to idiopathic scoliosis appears certain with known high prevalence
within families; however, the pattern of inherited susceptibility is unclear. Once a
spine is in a susceptible position, a variety of factors (neurologic, hormonal, and
other) individually or in concert may set the stage for progressive scoliosis or
benign further growth. As the investigation into etiology of idiopathic scoliosis
drives on, it has become clear that our research efforts are complicated by the
cause vs. effect problem. The time course of pathogenesis and the fact that af¬
fected individuals bear structural changes of undetermined chronicity poses great
challenges.
The Kinematics of the Surgical Correction of Scoliotic Deformity 11
Stephen J. Tredwell and Bonita J. Sawatzky
This chapter examines the complexities of scoliosis correction based on intra
operative analyses. The analyses describe the helical nature of the scoliotic de¬
formity while showing that surgical correction allows intersegmental changes as
well as en bloc movements to obtain correction. The understanding of the
three dimensional movements at the vertebral and the global level during correc¬
tion is still incomplete; however, as experimental methods become more accu¬
rate, the intrinsic mechanisms of correction will only become better understood.
Simulation models prior to surgical correction will become possible and intra
operative examination and measurement will then be used as a guide to surgical
correction.
iii
iv Contents
Brace Treatment of Idiopathic Scoliosis:
What Makes Sense in the New Millennium 21
John B. Emans
Brace treatment can alter the natural history of moderate idiopathic scoliosis.
Appropriately indicated, skillfully prescribed, and well constructed braces can
work to diminish the need for arthrodesis in idiopathic scoliosis and significantly
alter the natural history of idiopathic scoliosis over the course of bracing and in
short term and early long term follow up. Bracing seems to be dose related, and
full time bracing seems to be more effective for larger curves and perhaps for
double curves. For some individuals, the beneficial effect of bracing may be partly
lost over a lifetime, but there seem to be no long term adverse effects on bone den¬
sity or psychological status. Knowledge and diligence on the part of the orthopedic
surgeon makes a favorable outcome more likely.
The Surgical Evaluation and Analysis of
the Deformed Spine 45
Marc A. Asher and Douglas C. Burton
Idiopathic scoliosis is a complex three dimensional deformity that can be more
simply understood as a three planar deformity. After a diagnosis of idiopathic
scoliosis is made and the need for surgery is indicated, a thorough characteriza¬
tion of the scoliotic deformity is necessary before proceeding to surgery. Surgical
planning involves identifying the portion of the spine to be treated by surgical
correction and the portions of the spine that can be expected to maintain adequate
alignment through compensation. This chapter provides a framework for the
three planar analysis of the deformity, some guidelines for instrumentation and
fusion level selection, and the approaches to use.
Posterior Hook/Screw/Rod Constructs 61
Harry L. Shufflebarger
Correction and fusion in scoliosis should be accomplished on all structural curves,
including those in the sagittal plane. Fusion levels are determined by physical and
radiographic examination. King II curves present the greatest challenge, that being
the decision for selective thoracic fusion. Selective thoracic fusion should be
avoided in large lumbar curves and in those with fixed axial rotation. A horizontal
lowest instrumented vertebra is the goal. Spinal anchor sites can be deduced from
the sagittal plane requirements of the deformity in conjunction with the coronal
deformity. Anchors should be placed at nearly every spinal level, particularly
distal to T10. Screws or hooks may be used as spinal anchors, with screws gener¬
ally preferable in the lumbar spine. Mechanisms of deformity correction are trans¬
lation and angulation, which are accomplished either by direct translation or by
cantilever maneuvers.
Hybrid Posterior Spinal Segmental Instrumentation for
Adolescent Idiopathic Scoliosis 77
Lee S. Segal
The three dimensional analysis of idiopathic scoliosis as a torsional deformity
provides an ideal conceptual framework for the integration of multiple anchor or
hybrid posterior spinal segmental instrumentation. A torsional classification of
scoliosis has evolved from the King Moe classification. Thoughtful preoperative
planning is required to determine the selection of instrumented end vertebrae, the
Contents v
application and sequence of corrective forces, and various anchors used for spinal
segmental instrumentation. The traditional goals of surgery remain unchanged.
Techniques for the use of hooks, sublaminar or subpars wires, and pedicle screws
are discussed. Strategies for single and double torsional scoliosis patterns using
hybrid posterior instrumentation are presented.
Thoracoplasty 89
David M. Wallach
Rib deformities are significant problems that are minimally and inconsistently cor¬
rected with modern instrumentation. Therefore, various techniques for rib promi¬
nence reduction or thoracoplasty have been developed. The purpose of this article
is to discuss the merits of different types of thoracoplasty, a suggested method of
performing a convex thoracoplasty, and ways to avoid the pitfalls inherent in the
procedure. A convex thoracoplasty can greatly reduce a rib prominence and yield
results that patients will find aesthetically pleasing. In addition, convex thora¬
coplasty provides an excellent source of autogenous bone graft without increasing
the operative time or blood loss when compared to iliac crest bone grafting. The
usefulness of the concave thoracoplasty is less clear. It can be a good choice for im¬
proving coronal flexibility in the patient with a stiff curve (less than 35% correc¬
tion), a moderate rib prominence, and normal thoracic kyphosis.
Open and Endoscopic Anterior Approaches to
Spinal Deformity 103
Peter O. Newton
Open approaches to the anterior spine are commonly indicated for the treatment of
pediatric spinal deformity. Minimally invasive techniques have advanced to the
point of becoming practical, particularly in the thoracic spine. The thoracoscopic
approach for anterior disc excision and fusion in patients with scoliosis and
kyphosis is an option that has been gaining in popularity. Thoracoscopy has ad¬
vantages compared to an open thoracotomy, although learning the technique can
be time consuming and requires diligence. Technological advances in this ap¬
proach should be expected in the future. The surgical technique and outcomes are
summarized in this chapter.
Anterior Instrumentation 115
Randal R. Betz, Lawrence G. Lenke, Jiirgen Harms, David H. Clements,
Thomas G. Lowe, Thomas R. Haher, Peter O. Newton, Andrew A. Merola,
and Dennis R. Wenger
This article focuses on the indications for anterior instrumentation in thoracic scol¬
iosis. The reported indications for anterior instrumentation in idiopathic scoliosis
include the ability to save one or more distal fusion levels and to prevent crankshaft
phenomenon. Anterior instrumentation may be indicated in myelodysplasia be¬
cause of the absent posterior elements and the difficulty in posterior instrumenta¬
tion. It can be extremely helpful in cases of marked pelvic obliquity because of the
derotation of the thoracolumbar and lumbar spine segments that can be performed
with the anterior instrumentation. The surgical technique and variations of thoracic
instrumentation, including dual rod systems, are described in detail. The authors
present clinical results and complications, including spontaneous correction of the
lumbar curve, pulmonary function, and the benefits of the thoracoscopic approach
versus open thoracotomy.
vi Contents
Adolescent Kyphosis: Nonoperative and
Operative Treatment 127
Thomas G. Lowe
The successful nonoperative and operative treatment of kyphotic deformities in
adolescents requires an understanding of biomechanical principles and normal
sagittal profile and balance of the spine. Unlike brace treatment for scoliosis,
successful brace treatment for kyphosis in adolescents can be expected to pro¬
vide some long term modest improvement of the deformity. The use of anterior
structural support and interbody grafting in combination with posterior instru¬
mentation fusion provides the best chance of achieving a solid arthrodesis in
skeletally mature patients with kyphosis. Skeletally immature (Risser 3) pa¬
tients with flexible kyphosis can usually be managed by posterior only instru¬
mentation and fusion. Posterior constructs should have a minimum of eight
anchors above the apex (four on each side) and six to eight anchors below the
apex. Instrumentation levels should include the upper Cobb level proximally
and the first lordotic level distally. Excessive correction ( 50%) in patients
who are in negative sagittal balance preoperatively may result in junctional
kyphosis.
Reconstruction for Failed Fusion 141
Keith H. Bridwell
The most common causes for not achieving coronal balance are (1) failure to
distinguish between a false double major and a true double major curve, a
double thoracic and a single thoracic curve, or a single lumbar and a double
major curve; (2) crankshaft; (3) fusing too short; (4) correcting one curve more
than another in a structural double curve pattern; and (5) junctional implant pull
out. The most common causes of sagittal imbalance include (1) fusing too short;
(2) pull out of the instrumentation; and (3) fixing segments of the spine in
pathologic kyphosis coupled with subsequent breakdown of adjacent segments.
Pseudarthrosis is treated with lordization of the spine and, in some cases, cir¬
cumferential fusion. Fixed coronal and/or sagittal imbalance is surgically man¬
aged either with multiple Smith Petersen osteotomies or a pedicle subtraction
procedure.
Infantile and Juvenile Idiopathic Scoliosis 163
Richard E. McCarthy, Robert M. Campbell, Jr.,
and John E. Hall
Infantile and juvenile idiopathic scoliosis are pathologic entities with unknown
causes. The majority of patients with infantile scoliosis in the U.S. have a re¬
solving type of deformity that requires no treatment. Some require bracing treat¬
ment and a small number have a severe progressive type of deformity requiring
surgical intervention. Juvenile scoliosis has a similar course with a higher per¬
centage resulting in surgery. It is important to differentiate these patients from
those with syndromic, congenital, neuromuscular, or neurologic causes for their
curves. Careful evaluation and work up, including the use of MRI, studies has
been found efficient in the evaluation of these children. The principles guiding
the judicious use of treatment, be it bracing or surgery, should be guided by the
desire to improve the dimensions of the thoracic cavity in order to maximize
pulmonary development and function. Bracing and surgical techniques that
maximize the overall development and function of the child will lead to the
healthiest long term outcomes.
Contents vii
Instrumentation with Limited Arthrodesis for the Treatment of
Progressive Early Onset Scoliosis 181
Behrooz A. Akbarnia and David S. Marks
Spinal deformity can manifest early in life and may be progressive. Surgical
treatment of a selected group of very young children with truly progressive
curves not responding to usual nonoperative treatment methods is discussed.
These curves are considered to be one of the most challenging problems in pedi
atric orthopedics. Instrumentation with limited arthrodesis (of the upper and
lower foundations) provides curve correction, while at the same time attempting
to normalize the spinal growth. The use of a dual rod technique has reduced the
rate of complications.
Congenital Deformities 191
John E. Lonstein
Congenital spine deformities are due to developmental errors resulting in a fail¬
ure of formation, a failure of segmentation, or a combined type occurring in any
area of the vertebral ring. The resultant growth imbalance results in scoliosis,
kyphosis, lordosis, or a combination of these deformities. The natural history de¬
pends on the anomaly, the resultant deformity, and the area of the spine involved.
The evaluation of the patient must include evaluation of possible accompanying
anomalies (spinal cord, kidneys, and heart). The treatment is observation in scol¬
iosis where the natural history is unclear, bracing for decompensation or compen¬
satory curves, and, more commonly, surgery. The surgical procedure is tailored
for the patient and depends on the specific anomaly, the extent of the deformity,
and the age at treatment.
Congenital Scoliosis Due to Multiple Vertebral Anomalies
Associated with Thoracic Insufficiency Syndrome 209
Robert M. Campbell, Jr.
Congenital scoliosis due to multilevel vertebral anomalies may have associated
segmental hypoplasia of the rib cage due to fused ribs or chest wall instability re¬
sulting from absent ribs. This may result in thoracic insufficiency syndrome, which
is the inability of the thorax to support normal respiration or lung growth. Spinal
surgery alone does not well address the global thoracic deformity, but expansion
thoracoplasty by a titanium rib prosthesis allows direct treatment of the thoracic
deficit with indirect correction of the scoliosis without the need for spinal fusion.
Treatment of spine deformity in the very young child should preserve the growth
potential of the spine as the posterior pillar of the thorax and improve volume, sym¬
metry, and function of the thorax to make possible a lung vital capacity by skeletal
maturity compatible with long term survival of the patient.
Neuromuscular Scoliosis 219
John V. Banta
With the increased prevalence of children with neuromuscular disorders, more chil¬
dren survive with progressive spinal curves of neuromuscular origin. Surgical com¬
plications occur in more than 10% of patients currently undergoing spinal fusion
and instrumentation. Preoperative planning requires careful assessment of not only
the nutritional status of the patient but a thorough understanding of the specific po¬
tential problems related to the child s neuromuscular condition, including drug in¬
teractions and possible latex allergy. Surgical outcomes are improved in select
viii Contents
cases with large curves by performing sequential anterior and posterior fusion
under the same anesthetic. Segmental spinal fixation techniques provide the opti¬
mum potential correction of deformity but careful preoperative planning is manda¬
tory to correct not only coronal but also sagittal and transverse plane deformity.
Back Pain 233
Malcolm L. Ecker
This chapter presents an overview of back pain in children and adolescents and
emphasizes the importance of a thorough history and physical examination to de¬
termine which studies are most appropriate to achieve an efficient and economi¬
cal approach. The prevalence of back pain varies from less than 1 % under age 10
to 30 50% at age 15. In many older children a clearly defined organic etiology
will not be found. The specific indications for various imaging and laboratory
studies are reviewed and a diagnostic algorithm is presented. The more common
entities that cause back pain are discussed with regard to their presenting symp¬
toms and signs, indicated diagnostic studies, and an overview of management
and outcomes.
Spine Trauma in the Pediatric Population 249
John M. Flynn
Pediatric spinal injuries, although relatively uncommon, deserve special attention.
Mechanisms of injury include falls, motor vehicle accidents, birth injuries, and
child abuse. Plain radiographs alone may miss up to 50% of spinal injuries in chil¬
dren. MRI is becoming the preferred evaluation tool for the intubated, obtunded
child with a potential spinal injury. Spinal cord injury without radiographic
abnormality (SCIWORA) occurs most commonly at the cervicothoracic junction
and in children younger than 8 years. Many cervical spine injuries are treated
with halo immobilization, which can be modified for even the smallest children.
Cervical fusions can usually be achieved without wiring in children younger than
6 years. In older children and adolescents, the Gallie or Brooks techniques have
been the most popular fusion and stabilization methods. Chance fractures are
fixed by recreating a posterior tension band, either with intraspinous wiring in
small children or posterior compression constructs in older or larger children.
Benign and Malignant Tumors of the Spine in Children 263
John P. Dormans and Stephan G. Pill
Spinal tumors in children are very uncommon. The majority are benign; malignant
spinal tumors are fortunately very rare. Early recognition and diagnosis may im¬
prove the child s prognosis. New and improved imaging modalities offer im¬
proved abilities to evaluate these patients. There is also a better understanding of
the behavior and natural history of specific tumors and tumor like processes.
Newer surgical techniques for biopsy and definitive management (for local con¬
trol and reconstruction) now offer better options for children with both benign
and malignant spinal neoplasms. With malignant lesions, a multidisciplinary ap¬
proach including chemotherapy and surgery is required, preferably at a center
with considerable experience in managing children with benign and malignant
musculoskeletal tumors. Future progress will involve the development of better
imaging techniques, improving surgical techniques, and new and better adjuvant
modalities, including chemotherapy. Lastly, and maybe most importantly, a better
understanding of the etiology and natural history of these entities is the focus for
future progress.
Contents ix
Neurologic Injury Complicating Surgery for Spinal Deformity:
Etiology, Prevention, and Treatment 281
James Farmer and Denis S. Drummond
The risk of neurologic complications occurring with surgical correction of spinal
deformity is related to the size and rigidity of the curve, congenital deformity,
kyphosis, and the presence of intraspinal pathology. Further, technological im¬
provements have led to the development of newer implant systems with powerful
potential for correction, but with a greater risk of neurologic sequelae. To better
avoid these problems, the surgeon must develop an appreciation of spinal
anatomy, an understanding of the risks inherent with each type of implant, and the
safest way to insert them and apply correction. Further, an understanding of spinal
cord monitoring during surgery and a plan of how to respond to neurophysiologic
changes observed at the time of surgery give the best chance for prevention of a
permanent deficit.
Index 293
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| publishDateSearch | 2000 |
| publishDateSort | 2000 |
| publisher | Hanley & Belfus |
| record_format | marc |
| series | Spine |
| series2 | Spine |
| spelling | Strategies in the pediatric spine ed.: Denis S. Drummond Philadelphia Hanley & Belfus 2000 XIX, 298 S. zahlr. Ill., graph. Darst. txt rdacontent n rdamedia nc rdacarrier Spine 14,1 Child Infant Scoliosis Scoliosis in children Treatment Scoliosis Adolescent Spinal Diseases Spinal Diseases Adolescent Spinal cord Diseases Treatment Wirbelsäulendeformität (DE-588)4193783-1 gnd rswk-swf Skoliose (DE-588)4055267-6 gnd rswk-swf Kind (DE-588)4030550-8 gnd rswk-swf (DE-588)4143413-4 Aufsatzsammlung gnd-content Skoliose (DE-588)4055267-6 s Kind (DE-588)4030550-8 s DE-604 Wirbelsäulendeformität (DE-588)4193783-1 s Drummond, Denis S. Sonstige oth Spine 14,1 (DE-604)BV000700970 14,1 HBZ Datenaustausch application/pdf http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=008904912&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA Inhaltsverzeichnis |
| spellingShingle | Strategies in the pediatric spine Spine Child Infant Scoliosis Scoliosis in children Treatment Scoliosis Adolescent Spinal Diseases Spinal Diseases Adolescent Spinal cord Diseases Treatment Wirbelsäulendeformität (DE-588)4193783-1 gnd Skoliose (DE-588)4055267-6 gnd Kind (DE-588)4030550-8 gnd |
| subject_GND | (DE-588)4193783-1 (DE-588)4055267-6 (DE-588)4030550-8 (DE-588)4143413-4 |
| title | Strategies in the pediatric spine |
| title_auth | Strategies in the pediatric spine |
| title_exact_search | Strategies in the pediatric spine |
| title_full | Strategies in the pediatric spine ed.: Denis S. Drummond |
| title_fullStr | Strategies in the pediatric spine ed.: Denis S. Drummond |
| title_full_unstemmed | Strategies in the pediatric spine ed.: Denis S. Drummond |
| title_short | Strategies in the pediatric spine |
| title_sort | strategies in the pediatric spine |
| topic | Child Infant Scoliosis Scoliosis in children Treatment Scoliosis Adolescent Spinal Diseases Spinal Diseases Adolescent Spinal cord Diseases Treatment Wirbelsäulendeformität (DE-588)4193783-1 gnd Skoliose (DE-588)4055267-6 gnd Kind (DE-588)4030550-8 gnd |
| topic_facet | Child Infant Scoliosis Scoliosis in children Treatment Scoliosis Adolescent Spinal Diseases Spinal Diseases Adolescent Spinal cord Diseases Treatment Wirbelsäulendeformität Skoliose Kind Aufsatzsammlung |
| url | http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=008904912&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA |
| volume_link | (DE-604)BV000700970 |
| work_keys_str_mv | AT drummonddeniss strategiesinthepediatricspine |