Evolution of treatment of paralytic scoliosis at Rancho Los Amigos Hospital

Bonnett, Charles A.; Brown, JC; Perry, John F.; Vl, Nickel; Walinski, T; Brooks, Lee J.; Hoffer, M. Mark; Stiles, C. W.; Brooks, Rebecca H.

doi:10.2106/00004623-197557020-00013

Cited by 60 publications

(27 citation statements)

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“…With the advent of Harrington instrumentation significant improvement in curve correction, retardation of curve progression and decrease in postoperative recumbence period was seen [10]. Initial single rod-long segment fixation techniques were superseded by segmental fixations in order achieve a better correction, avoid post-operative immobilization and reduce loss of correction over time [12].…”

Section: Discussionmentioning

confidence: 99%

“…Surgical techniques described so far in scoliosis correction in DMD patients range from halo casts with traction wires and buttons [10], Harrington rods [11], Luque's segmental spinal fixation [12] to more recent techniques using pedicle screws and hooks. The older techniques have fallen out of favour in recent years chiefly due to the biomechanical advantages offered by the newer constructs such as a stronger corrective force and increased strength thereby providing a prolonged maintenance of correction.…”

Section: Introductionmentioning

confidence: 99%

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Scoliosis in Duchenne’s muscular dystrophy: a changing trend in surgical management

Arun

Srinivas²,

Mehdian³

2009

Eur Spine J

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A non-randomised retrospective study to compare the results of surgical correction of scoliosis in Duchenne's muscular dystrophy (DMD) patients using three different instrumentation systems-Sublaminar instrumentation system (Group A), a hybrid of sublaminar and pedicle screw systems (Group B) and pedicle screw system alone (Group C). Between 1993 and 2003, 43 patients with DMD underwent posterior spinal fusion and instrumentation. Group A (n = 19) had sublaminar instrumentation system, Group B (n = 13) had a hybrid construct and Group C (n = 11) was treated with pedicle system. The mean blood loss in Group A was 4.1 l, 3.2 l in Group B and 2.5 l in Group C. Average operating times in Group A, B and C were 300, 274 and 234 min, respectively. Mean pre-operative, post-operative and final Cobb angle in Group A was 50.05 ± 15.46°, 15.68 ± 11.23°and 21.57 ± 11.63°, Group B was 17.76 ± 8.50°, 3.61 ± 2.53°and 6.69 ± 4.19°and Group C was 25.81 ± 9.94°, 5.45 ± 3.88°, 8.90 ± 5.82°, respectively. Flexibility index or the potential correction calculated from bending radiographs were 60 ± 6.33, 70 ± 4.65 and 67 ± 6.79% for Group A, Group B and Group C respectively. The percentage correction achieved was 72.5 ± 14.5% in Group A, 82 ± 6% in Group B and 82 ± 8% in Group C. The difference between percentage correction achieved and the flexibility index was 12.45 ± 8.22, 12.05 ± 1.3 and 15.00 ± 1.21% in Group A, B and C, respectively The percentage loss of correction in Cobb angles at final follow-up in Group A, B and C was 12.5 ± 3.5, 16.5 ± 1. and 12.5 ± 2.5%, respectively. Complications seen in Group A were three cases of wound infection and two cases of implant failure; Group B had a single case of implant failure and Group C had one patient with wound infection and one case with a partial screw pull out. Early surgery and smaller curve corrections appears to be the current trend in the management of scoliosis in DMD. This has been possible due to early curve detection and surgery thus having the advantage of less post-operative respiratory complications and stay in paediatric intensive care. Also, early surgery avoids development of pelvic deformity and extension of instrumentation to the pelvis thereby reducing blood loss. This trend reflects the advent of newer and safer instrumentation systems, advanced techniques in anaesthesia and cord monitoring. Sublaminar instrumentation system group had increased operating times and blood loss compared to both the hybrid and pedicle screw instrumentation systems due to increased bleeding from epidural vessels and pelvic instrumentation. Overall, the three instrumentation constructs appear to provide and maintain an optimal degree of correction at medium to long term follow up but the advantages of lesser blood loss and surgical time without the need for pelvic fixation seem to swing the verdict in favour of the pedicle screw system.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Scoliosis in Duchenne’s muscular dystrophy: a changing trend in surgical management

Arun

Srinivas²,

Mehdian³

2009

Eur Spine J

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“…If anterior Dwyer fusion was added, hardware failures decreased to 9% and pseudarthrosis to 11%. Ward et al [20] reported 19 different hardware problems in 38 patients, Bonnet et al [3] reported 34% hardware problems, Kumar and Townsend [12] 26% pseudarthrosis or hardware problems, and Keessen et al [11] 24.6% failures of instrumentation.…”

Section: Surgical Techniquementioning

confidence: 99%

Complications of scoliosis surgery in children with myelomeningocele

1999

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The purpose of the present study was to evaluate whether the high incidence of complications in scoliosis surgery in myelomeningocele (MMC) could be attributed to the surgical technique and whether improvements were possible. Between 1984 and 1996, 77 patients with MMC and scoliosis were treated surgically. The clinical and radiological follow-up ranged from 1 to 10 years with a mean follow-up of 3.6 years. The mean age at time of surgery was 12 years 8 months. The average preoperative scoliosis measured 90.20°and was corrected by 47%. The first four patients were stabilized with Harrington rods after anterior correction with a Zielke device (group 1). Twenty-five patients were operated only from posterior, using Cotrel-Dubousset (CD) instrumentation (group 2). In 13 patients an anterior release and discectomy was performed prior to CD posterior instrumentation (group 3). In 26 patients (group 4) this was combined with an anterior instrumentation. The 9 patients of group 5 had congenital vertebral malformations which made a special treatment necessary. Complications could be divided into hardware problems, such as implant failure, dislocation or pseudarthrosis, infections, anesthetic, and neurologic complications. Hardware problems were seen in 29% of all patients. More hardware problems were seen with the Harrington rod (75%) and after solitary posterior instrumentation (30%). The occurrence of pseudarthrosis was dependent on the surgical technique, the extent of posterior spondylodesis, and lumbosacral fusion. Patients with hardware problems had a mean loss of correction of 49% compared to 13% in the other patients. Depending on the different surgical techniques a loss of more than 30% was seen in 12-75% of the cases. Early postoperative shunt failure occurred in four cases; delayed failure -after more than 1 year -in three cases. One patient died within 1 day due to an acute hydrocephalus, another died after 2 1 /2 years because of chronic shunt insufficiency with herniation. Wound problems were not dependent on the surgical technique, but on the extent of posterior spondylodesis and the lumbosacral fusion. Based on this analysis we believe our current practice of instrumented anterior and posterior fusion is justified. Further, we are very careful to check shunt function prior to acute correction of spinal deformity.

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“…Scoliosis surgery should be early enough in the course of the underlying disease, when cardiac and pulmonary function is sufficient, so that patients can be anaesthetised and operated relatively safely in order to reduce the likelihood of major complications [1,3,22].…”

Section: Discussionmentioning

confidence: 99%

Surgical management of severe scoliosis with high risk pulmonary dysfunction in Duchenne muscular dystrophy: patient function, quality of life and satisfaction

Takaso

Nakazawa

Imura

et al. 2010

International Orthopaedics (SICOT)

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In a previous study, the authors reported the clinical and radiological results of Duchenne muscular dystrophy (DMD) scoliosis surgery in 14 patients with a low FVC of <30%. The purpose of this study was to determine if surgery improved function and QOL in these patients. Furthermore, the authors assessed the patients' and parents' satisfaction. %FVC increased in all patients after preoperative inspiratory muscle training. Scoliosis surgery in this group of patients presented no increased risk of major complications. All-screw constructions and fusion offered the ability to correct spinal deformity in the coronal and pelvic obliquity initially, intermediate and long-term. All patients were encouraged to continue inspiratory muscle training after surgery. The mean rate of %FVC decline after surgery was 3.6% per year. Most patients and parents believed scoliosis surgery improved their function, sitting balance and quality of life even though patients were at high risk for major complications. Their satisfaction was also high.

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Evolution of treatment of paralytic scoliosis at Rancho Los Amigos Hospital

Cited by 60 publications

References 0 publications

Scoliosis in Duchenne’s muscular dystrophy: a changing trend in surgical management

Scoliosis in Duchenne’s muscular dystrophy: a changing trend in surgical management

Complications of scoliosis surgery in children with myelomeningocele

Surgical management of severe scoliosis with high risk pulmonary dysfunction in Duchenne muscular dystrophy: patient function, quality of life and satisfaction

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