S urgical treatments for adult spinal deformity (ASD) are typically complex procedures associated with significant blood loss and the potential risk for perioperative coagulopathy, as well as requisite blood product administration, volume resuscitation, and their associated risks. 28 , 29 Acute intraoperative blood loss can be managed with allogeneic transfusions; however, the risks include transfusion-related acute lung injury, hemolytic transfusion reactions, and transfusion-associated sepsis. 31 Reducing perioperative blood loss in complex spine surgery is
Bhargav D. Desai, Davis G. Taylor, Ching-Jen Chen, Thomas J. Buell, Jeffrey P. Mullin, Bhiken I. Naik, Justin S. Smith and Christopher I. Shaffrey
Cheerag Upadhyaya, John Ziewacs and Praveen Mummaneni
Minimally invasive surgical (MIS) approaches are gaining popularity in many surgical fields. Potential advantages include reduced blood loss, shorter length of stay, and less soft-tissue trauma. Potential disadvantages include inadequate deformity correction, increased fluoroscopy, longer operative times, and decreased posterolateral fusion surface area exposure.
This video demonstrates the key steps in our mini-open transforaminal lumbar interbody fusion (TLIF) using an expandable tubular retractor, placement of cannulated pedicle instrumentation, and subsequent deformity correction. The video demonstrates positioning, surgical opening through a midline incision, a bilateral Wiltse plane tubular approach for the TLIF, placement of bilateral cannulated pedicle screws, and deformity correction.
The video can be found here: http://youtu.be/9GH3qsCGX3E.
demonstrated on flexion and extension, however, correlated with improved functional performance (p = 0.005). Conclusions. Kyphosis may develop in up to 21% of patients who have undergone laminectomy for CSM. Progression of the deformity appears to be more than twice as likely if preoperative radiological studies demonstrate a straight spine. In this study, clinical outcome did not correlate with either pre- or postoperative sagittal alignment. I read with interest the paper of Kaptain, et al. (G. J. Kaptain, N. E. Simmons, R. E. Replogle, et al: Incidence and
Owoicho Adogwa, Aladine A. Elsamadicy, Victoria D. Vuong, Jared Fialkoff, Joseph Cheng, Isaac O. Karikari and Carlos A. Bagley
at a major academic medical center. Institutional review board approval was obtained prior to the study’s initiation. We included patients 65 years and older with 1) back pain and/or radiculopathy, 2) radiographic evidence of thoracolumbar deformity, 3) failed nonsurgical treatment, and 4) history of multilevel lumbar decompression and fusion. Patients were excluded if they had severe coexistent pathology that could confound assessment of operative outcome or were unwilling to participate in the study. All patients had a minimum of 2 years of follow-up. The
Cormac O. Maher, Steven R. Buchman, Edward O'Hara and Aaron A. Cohen-Gadol
A lthough there are numerous premodern descriptions of craniosynostosis, the scientific basis for the surgical correction of craniosynostosis dates to the early 19th century. Early pioneers in this work included Samuel von Sömmerring (1755–1830) and Rudolf Virchow (1821–1902). In 1800, von Sömmerring's description of cranial sutures and their role in cranial vault development and growth suggested that premature suture closure would lead to subsequent cranial deformity. 18 In 1851, Virchow published his paper, giving rise to Virchow's law: “When premature
Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004
Robert F. Heary
T he first record of scoliosis was by Hippocrates. In ancient times traction was attempted, unsuccessfully, to correct scoliotic deformity. In the 16th century, Ambroise Paré is credited with describing the first application of a brace to treat scoliosis. Paré used an iron corset to correct coronal-plane deformity. In 1962, Harrington 20 reported the first successful use of spinal implants in the correction of scoliosis. As such, the modern era of deformity correction involving the placement of spinal instrumentation began. The Scoliosis Research Society, the
Daniel J. Hoh, Paul Khoueir and Michael Y. Wang
A nkylosing spondylitis is an inflammatory condition that can lead to severe pain, disability, spinal fractures, and deformity. Although the underlying cause of AS is unclear, its pathogenesis is an immune-mediated erosion of the joints of the axial skeleton. The spine is particularly targeted, with involvement of the vertebral joints and the intervertebral disc spaces. Lymphocytic infiltration of the disc space leads to degeneration of the junction of the anulus fibrosus and the vertebral endplates. Progressive erosion of these joints is followed by
Jeff Dror Golan, Jeffery Alan Hall, Gus O'Gorman, Chantal Poulin, Thierry Ezer Benaroch, Marie-Andrée Cantin and Jean-Pierre Farmer
Despite these benefits, severe spinal deformities requiring surgical correction have also been reported. 9 , 27 , 40 , 41 , 45 , 47 In studies of the natural history of the disease, investigators have reported the radiologically documented incidence of scoliosis in young adults with CP to be 44% in independently ambulatory patients and 76% in bedridden patients. 20 The presence of spasticity, the severity of neurological dysfunction, and the patient's ambulatory status appear to be important factors in the development of scoliosis in patients with CP. 20 , 21 , 37
Naoko Araya, Hiroyuki Inose, Tsuyoshi Kato, Masanori Saito, Satoshi Sumiya, Tsuyoshi Yamada, Toshitaka Yoshii, Shigenori Kawabata and Atsushi Okawa
documented scoliosis caused by HIES, which was discovered following corrective surgery that had resulted in postoperative infection. 13 To our knowledge, the present report is the first on the surgical treatment of spinal deformity caused by HIES, which was diagnosed presurgery. Here we describe the case of a surgically treated spinal deformity caused by HIES and discuss various perioperative prophylaxes for preventing postoperative infections in patients with HIES. Case Report History and Examination A 16-year-old male reported back pain with no evidence of
Praveen V. Mummaneni, Sanjay S. Dhall, Gerald E. Rodts and Regis W. Haid
C ervical kyphosis is a particularly challenging problem that can result in progressive deformity and neurological decline. 5 , 43 Advances in spinal instrumentation have led to refinements in the treatment of cervical kyphotic deformity. 15 , 22 , 31 Though it is generally accepted that surgical correction is warranted in cases of progression of kyphosis or neurological decline, the choice of ventral, dorsal, ventral-dorsal, or 3-stage approaches remains debatable. 5 Although many cases of cervical kyphotic deformity can be corrected via an anterior